Treatment with polysorbate 80-solved Docetaxel (Taxotere®) is hampered by the requirement to co-administer steroids. Chronic (intermittent) steroids are negatively impacting bone health and have well known immunosuppressive effects. Despite steroid premedication, polysorbate 80-solved Docetaxel (Taxotere®) results in occasional infusion reactions due to the solvent polysorbate 80. Docetaxel micellar is a promising alternative to polysorbate 80-solved Docetaxel (Taxotere) as it avoids the mandatory need for steroid administration pre and post infusion, and thus avoids immunosuppressive and bone-damaging effects. There is an unmet medical need to develop steroid-free taxane regimens for patients with advanced cancer to avoid the need for steroid administration pre and post infusion (as outlined above). The unique Docetaxel micellar formulation suggests an improved safety profile compared to polysorbate 80-solved Docetaxel (Taxotere®).
Docetaxel, a semi-synthetic analogue of paclitaxel, is one of the most widely used human anti-cancer agents. Docetaxel and paclitaxel belong to a group of cytotoxic agents called taxanes. Docetaxel has been marketed worldwide by Sanofi-Aventis under the trade name Taxotere® and its use is approved for different types of solid tumors. The efficacy of docetaxel has been proven in two different phase 3 trials in metastatic castration resistant prostate cancer (mCRPC) and is a standard of care option for patients with prostate cancer. In Taxotere®, polysorbate 80 is used as surfactant. Fluid retention and hypersensitivity reactions are reported, and the patients are pre-treated with corticosteroids, e.g. dexamethasone, to avoid or at least reduce the frequency and the severity of both hypersensitivity reactions and fluid retention. Oasmia Pharmaceutical AB (Uppsala, Sweden) has developed a novel formulation of docetaxel (Docetaxel micellar) with N-(all-trans-retinoyl)-L-cysteic acid methyl ester sodium salt (XMeNa) as excipient, thus reducing adverse reactions caused by polysorbate 80. XMeNa forms micelles into which docetaxel can be incorporated thus increasing its aqueous solubility and keeping it dissolved. Rational Treatment with polysorbate 80-solved Docetaxel (Taxotere) is hampered by the requirement to co-administer steroid pre and post Taxotere infusion. Chronic (intermittent) steroids are hurting bone health and have well known immunosuppressive effects. Despite steroid premedication, polysorbate 80-solved Docetaxel (Taxotere) results in occasional infusion reactions due to the solvent polysorbate 80. The new micellar formulation of docetaxel is a promising alternative to polysorbate 80-solved Docetaxel (Taxotere) as it avoids the mandatory need for steroid administration pre and post infusion, and thus avoids immunosuppressive and bone-damaging effects. Safety and pharmacokinetics (PK) of Docetaxel micellar have been assessed in 2 clinical studies, but only in breast cancer patients. This is the first clinical trial to assess the safety and tolerability of 3-weekly intravenous Docetaxel micellar infusions in patients with mCRPC. The primary objective of this study is to determine the maximum tolerated dose (MTD) and the recommended phase II dose (RP2D) for Docetaxel micellar in patients with mCRPC.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
There will be three dose levels, 1-3, with each level consisting initially of a cohort containing 3 patients. One additional dose level, dose level -1, shall be allowed in the event that dose level 1 is considered too toxic
IOSI - Ospedale Regionale Bellinzona e Valli
Bellinzona, Switzerland
Kantonsspital Graubuenden
Chur, Switzerland
Kantonsspital St. Gallen
Sankt Gallen, Switzerland
Dose-limiting toxicity (DLT)
DLT is defined as the occurrence of any of a set of specified hematological, hepatic, gastro-intestinal, nervous systems disorders, fluid retention or other adverse events (AEs) which: * occur during cycle 1 of the trial treatment defined as the DLT monitoring period * is considered by the Investigator or the Sponsor to be at least possibly related to the IMP.
Time frame: at the end of Cycle 1 (each cycle is 21 days)
Radiographic progression-free survival (rPFS)
rPFS is defined as the time from treatment start to radiographic progression, or death due to any cause, whichever occurs first. The assessment of radiographic disease progression is based on local evaluations.
Time frame: from date of treatment start to date of radiographic progression, or death due to any cause, whichever occurs first, assessed up to 36 months
Time to PSA progression
Time to PSA progression is defined as the time from treatment start to the time point of PSA progression. The PSA progression date is defined as the date of * ≥ 25% increase AND ≥ 2 ng/mL increase above the nadir, confirmed by a second value ≥ 3 weeks later, if there is PSA decline from baseline (last PSA measurement before treatment start), or * ≥ 25% increase AND ≥ 2 ng/mL increase from baseline beyond 12 weeks if there is no PSA decline from baseline Time to PSA progression is defined as the time from treatment start to the time point of PSA progression. The PSA progression date is defined as the date of * ≥ 25% increase AND ≥ 2 ng/mL increase above the nadir, confirmed by a second value ≥ 3 weeks later, if there is PSA decline from baseline (last PSA measurement before treatment start), or * ≥ 25% increase AND ≥ 2 ng/mL increase from baseline beyond 12 weeks if there is no PSA decline from baseline
Time frame: from date of treatment start to date of PSA progression, or start of a subsequent anticancer treatment, whichever occurs first, assessed up to 36 months
PSA response
PSA response is defined as a PSA decline of ≥ 50% from baseline measured twice at least 3 weeks apart during treatment.
Time frame: from date of treatment start to date of end of treatment, assessed up to 30 weeks
Partial (PR) or complete (CR) radiological soft tissue response according to RECIST 1.1
Partial (PR) or complete (CR) radiological soft tissue response achieved according to RECIST 1.1 criteria. Patients without any response assessment during trial treatment will be considered as having a non-evaluable response (NE) and thus will be regarded as failure for this endpoint.
Time frame: from date of treatment start to date of end of treatment, assessed up to 30 weeks
Duration of response (DoR) according to RECIST 1.1
DoR is defined as the time from the earliest date of the first documented evidence of complete response (CR) or partial response (PR) until earliest date of disease progression according to RECIST 1.1 or death due to any cause, whichever occurs first. Patients not experiencing an event at the time of the analysis, as well as patients starting a subsequent anticancer treatment in the absence of an event, will be censored at the date of their last available tumor assessment before starting a subsequent anticancer treatment, if any.
Time frame: from date of response to date of disease progression according to RECIST 1.1 or death, whichever occurs first, assessed up to 36 months
Adverse Events
AEs will be assessed according to the NCI Common Terminology Criteria for Adverse Events (CTCAE v5.0).
Time frame: From registration until 28 days after last dose of trial treatment
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