The purpose of the initial (phase I) portion of this study is to find a dose level and administration schedule of the study drug, 225Ac-J591, that can be given without severe side effects. The purpose of the second (phase II) portion of the study is to determine the proportion of those with PSMA-positive tumors with \>50% PSA decline following 225Ac-J591 treatment in two regimens.
This clinical trial is for men with progressive metastatic castration resistant prostate cancer. The purpose of this study is to find the highest dose level of the study drug, 225Ac-J591, that can be given without severe side effects. The research study is being done because the standard treatments for prostate cancer that has spread beyond the prostate gland are intended to minimize the adverse effects of the disease. These treatments, however, are not curative. Patients who choose to participate in this study will have a screening visit to determine whether or not they are eligible to participate in the study. There are two different regimens for men with progressive mCRPC with and without prior 177Lu-PSMA-RL treatment. The fractionated dose regimen is a single cycle of study drug administered on Day 1 and Day 15. The dose-limiting toxicity assessment period is 8 weeks for the fractionated dose regimen (starting from Cycle 1 Day 1). The multiple dose regimen is a single dose of 225Ac-J591 per cycle, with each cycle administered every 6 weeks up to 4 cycles. The dose-limiting toxicity assessment period is up to 9 weeks past the 2nd dose of 225Ac-J591. Following treatment, short-term follow up is planned until radiographic progression, expected to be 6 months. The study medication is called 225Ac-J591, and is administered as a single fractionated cycle day 1 and day 15 in the fractionated dose regimen and as a single dose per cycle repeated every 6 weeks in the multiple dose regimen. Upon completion of investigational treatment with 225Ac-J591, participants will undergo 68Ga-PSMA-HBED-CC injection and same day PET/CT to document treatment response. 68Ga-PSMA-HBED-CC is comprised of gallium-68, which is a positron-emitting radionuclide linked to PSMA-HBED-CC (aka PSMA11), which is a small molecule targeting PSMA. 68Ga-PSMA-HBED-CC will be administered intravenously prior to PET/CT at screening and at follow up imaging x2. Subsequent survival data and additional treatment(s) information will be captured from their routine standard of care (SOC) visits. During the other study visits, participants will undergo routine tests and procedures, such as physical examinations, and blood tests. Some blood tests will be done for research purposes only. After completion of therapy, participants may be contacted on a periodic basis to see how they are doing.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Single cycle of fractionated dose of 225Ac-J591
68Ga-PSMA-HBED-CC PET/CT before and after treatment
Single dose of 225Ac-J591 every 6 weeks up to 4 cycles
Brooklyn Methodist Hospital - New York Presbyterian
Brooklyn, New York, United States
Weill Cornell Medicine
New York, New York, United States
Number of participants with dose limiting toxicity (DLT)
DLTs will be measured by utilizing the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time frame: Collected from Day 1 through 6 months
Cumulative maximum tolerated dose (MTD)
The dose that produces an "acceptable" level of toxicity or that, if exceeded, would put subjects at "unacceptable" risk for toxicity. MTD is defined as the dose level at which no more than two patients out of six experienced dose-limiting toxicity (DLT).
Time frame: Collected from Day 1 through 6 months
Recommended phase II dose (RP2D) of 225Ac-J591 in fractionated dose and multiple dose regimens both pre- and post-treatment with 177Lu-PSMA-RL
Time frame: Collected from Day 1 through 6 months
Proportion of participants with PSMA-positive tumors with >50% PSA decline following 225Ac-J591 in two regimens both pre- and post- treatment with 177Lu-PSMA-RL
Proportion of participants achieving greater than 50% PSA decline (relative to baseline/pre-treatment PSA). Response may occur at any time following treatment initiation and prior to going off study or initiation of new therapy.
Time frame: Collected from Day 1 through 6 months
Number of participants with radiographic response
Response evaluation criteria in solid tumors RECIST (Version 1.1) criteria with prostate cancer working group 3 (PCWG3) modifications to be used.
Time frame: Imaging performed at timepoints from Day 1 through study completion up to 3 years
Overall survival following 225Ac-J591 treatment
Overall survival will be captured through in-clinic or telephone contact with participants
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Time frame: Collected from Day 1 through study completion up to 3 years
Change in disease assessment with 68Ga-PSMA-11 PET/CT prior to and following investigational treatment
68Ga-PSMA-11 PET/CT will be utilized as part of the radiographic assessment.
Time frame: Scans will be performed at screening, day 85 and day 168
Change in circulating tumor cells (CTC) and the rate of favorable and undetectable CTC count at 12 weeks following 225Ac-J591
CTCs will be analyzed through blood specimen collection via CellSearch methodology lab testing
Time frame: Samples will be collected at screening, day 1, day 85 and at disease progression
Safety of treatment and adverse event rate
National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 is used to grade all adverse events
Time frame: Will be collected from Day 1 through study completion up to 3 years
Assess biochemical progression-free survival
PSA progression will be defined as a rise of \> 25% above either the pretreatment level or the nadir PSA level (whichever is lowest). PSA must increase by \> 2 ng/ml to be considered progression
Time frame: Will be collected from Day 1 through study completion up to 3 years
Assess the proportion with different levels of PSA decline following 225Ac-J591
PSA will be monitored through serial blood draws. Response may occur at any time following treatment initiation and prior to going off study or initiation of new therapy.
Time frame: Will be collected from Day 1 through study completion up to 3 years