This phase I/II trial tests the safety, side effects, and best dose of abemaciclib and whether it works before 177Lu-PSMA-617 in treating patients with castration resistant prostate cancer that has spread to other places in the body (metastatic). Abemaciclib is in a class of medications called kinase inhibitors. It is highly selective inhibitors of cyclin-dependent kinase 4 and 6, which are proteins involved in cell differentiation and growth. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. Radioligand therapy uses a small molecule (in this case 177Lu-PSMA-617), which carries a radioactive component to destroys tumor cells. When 177Lu-PSMA-617 is injected into the body, it attaches to the prostate-specific membrane antigen (PSMA) receptor found on tumor cells. After 177Lu-PSMA-617 attaches to the PSMA receptor, its radiation component destroys the tumor cell. Giving abemaciclib before 177Lu-PSMA-617 may help 177Lu-PSMA-617 kill more tumor cells.
PRIMARY OBJECTIVES: I. To determine the recommended phase II dose (RP2D) for abemaciclib given as lead-in treatment prior to lutetium Lu 177 vipivotide tetraxetan (177Lu-PSMA-617) for each treatment cycle, as well as dose limiting toxicities (DLTs) of this combination regimen. (Part A) II. To determine the change in prostate-specific membrane antigen (PSMA) uptake on gallium Ga 68 gozetotide (68Ga-PSMA-11) positron emission tomography (PET) scan following fourteen days of priming with abemaciclib treatment, relative to the pre-treatment baseline scan. (Part B (Expanded Cohort)). SECONDARY OBJECTIVES: I. To determine the (proportion of patients who experience \>= 50% decline from baseline in serum prostate specific antigen (PSA) (PSA50) response of this combination treatment. (Part B \[Expanded Cohort\]) II. To describe the safety of this combination treatment regimen using National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version (v.)5.0. (Part B \[Expanded Cohort\]) III. To determine the radiographic progression free survival (rPFS) according to Prostate Cancer Working Group 3 (PCWG3) guidelines among patients treated with this combination regimen. (Part B \[Expanded Cohort\]) IV. To determine the objective response rate (ORR) (complete response \[CR\] + partial response \[PR\]) as measured by Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 response in soft tissue, lymph node and visceral lesions. (Part B \[Expanded Cohort\]) V. To determine the disease control rate (DCR) (CR + PR + stable disease (SD)) as measured by RECIST v1.1 response in soft tissue, lymph node and visceral lesions. (Part B \[Expanded Cohort\]) VI. To determine the overall survival (OS) of patients treated with this combination regimen. (Part B \[Expanded Cohort\]) VII. To determine the median duration of response (DOR) in patients treated with this combination regimen who achieve CR or PR as measured by RECIST v1.1. (Part B \[Expanded Cohort\]) EXPLORATORY OBJECTIVES: I. To assess changes in tumor microenvironment using ribonucleic acid (RNA) and whole exome sequencing by comparing biopsies obtained pre and post-combination treatment using the established institutional biopsy protocol (PSMA biopsy study). II. To assess changes in PSMA expression in biopsies at the time of progression relative to pre-treatment biopsies using immunohistochemistry (IHC). III. To describe PSMA upregulation on imaging following 7 days of treatment with abemaciclib, and in particular compare to PSMA upregulation on imaging seen following 14 days of abemaciclib treatment. IV. To describe PSMA expression and upregulation on imaging following combined treatment with abemaciclib and 177Lu-PSMA-617 at the time of subsequent therapy cycles (pre and post abemaciclib treatment with cycle 3) in some patients treated with RP2D in Part B (expansion cohort). V. To describe patterns of progression following completion of treatment, including in patients with available 68Ga-PSMA-11 PET scans. VI. To compare response to treatment and clinical outcomes with different dose levels of abemaciclib used in this study. OUTLINE: This is a dose-escalation study of abemaciclib. Patients receive abemaciclib orally (PO) twice daily (BID) on days 1-14 and lutetium Lu 177 vipivotide tetraxetan intravenously (IV) over 30 minutes on day 15. Treatment repeats every 6 weeks for up to 4 cycles in the absence of disease progression or unacceptable toxicity. After completion of study intervention, patients are followed up at 30 days, and then will subsequently be followed for overall survival in the long-term follow-up period and contacted approximately every 3 months until consent is withdrawn, death occurs, patient is lost to follow-up or the study is concluded.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
30
Given Orally
Given IV
University of California, San Francisco
San Francisco, California, United States
RECRUITINGRecommended phase 2 dose (Part A)
If two or more patients in a cohort experience a dose-limiting toxicity (DLT), then the maximum tolerated dose (MTD)has been exceeded. The previous dose level will be considered the MTD and the recommended phase 2 dose. Per Investigator discretion, the recommended phase 2 dose/schedule of abemaciclib followed by 177Lu-PSMA-617 may be established in the absence of reaching MTD, based on the cumulative safety data of the treatment regimen.
Time frame: 6 weeks
Proportion of participants with DLTs (Part A)
Any non-hematologic, treatment-related adverse event (TRAE) Grade 3+, except of Grade 3 nausea,vomiting,diarrhea,constipation,fever,fatigue,skin rash,alopecia or non-clinically significant laboratory that resolves to Grade \<3 within 72 hours;Grade 4 thrombocytopenia lasting \>7 days;Grade 3+ thrombocytopenia with bleeding/requirement for platelet transfusion;Grade 4 neutropenia lasting \>7 days; Grade 3+ neutropenic fever;Grade 4+ anemia;TRAE requiring treatment discontinuation/delay of \>42 days;Failure to receive at least 66% of abemaciclib doses due to toxicity;Death not clearly due to underlying disease/extraneous causes;Hy's law;Grade 3+ nausea/vomiting/diarrhea \>72 hours;Grade 3+ fatigue \>7 days;Grade 3+ electrolyte abnormality \>72 hours, unless patient has clinical symptoms;All AEs of specified grades should count as DLTs except those that are clearly due to progression/extraneous causes.
Time frame: 6 weeks
Change in maximum standardized uptake value (SUVmax) across three lesions on gallium Ga 68 gozetotide (68Ga-PSMA-11) positron emission tomography (PET) scan (Part B)
The uptake in the three lesions with the highest SUVmax on the initial scan will be compared to SUVmax measurements in the same lesions on the PSMA PET scan following 14 days of priming treatment with abemaciclib
Time frame: Up to 24 weeks
PSA50 response rate (Part B)
The proportion of patients who achieve a greater than 50% decline from baseline prostate specific antigen (PSA) drawn prior to cycle 1 day 1, at any point in the treatment course, will be descriptively reported along with 95% binomial confidence interval.
Time frame: Up to 24 weeks
Proportion of participants with TRAEs (Part B)
Evaluated by National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0 CTCAE v.5) and defined as any adverse event which is classified by the investigator as having a definite, probable, or possible attribution to study treatments.
Time frame: Up to 30 days after last dose of study drug, approximately 28 weeks
Radiographic progression free survival (Part B)
Radiographic progression of disease will be defined by RECIST version 1.1 and Prostate Cancer Working Group 3 (PCWG3) criteria. For the first scheduled reassessment by bone scan, new bone lesions will require a confirmatory bone scan 6 or more weeks later. Median progression free survival will be estimated using the Kaplan-Meier method. Durations will be measured from the first day of study treatment (cycle 1) to the first date of radiographic progression or death, whichever occurs first. Patients who discontinue study treatment for toxicity, withdraw from the study, or have PSA-only progression will be censored at the date of the last radiographic tumor assessment. Patients who discontinue treatment for clinical progression or deterioration will be included in the analysis.
Time frame: Up to 2 years
Objective response rate (Part B)
Measured by Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 response in soft tissue, lymph node and visceral lesions. Objective response is defined as the best response (complete response or partial response) from the start of treatment until disease progression or recurrence, where the reference for progressive disease is the smallest measurements recorded from start of treatment. To be assigned a status of objective response (CR or PR), changes in tumor measurements must be confirmed by repeat scans no less than 4 weeks after the criteria for response are first met. The proportion of patients with objective response will be descriptively reported with 95% binomial confidence interval.
Time frame: Up to 24 weeks
Disease control rate (Part B)
Measured by RECIST version 1.1 response in soft tissue, lymph node and visceral lesions. Disease control rate is defined as patients achieving either the best response (complete response or partial response) or stable disease from the start of treatment until disease progression or recurrence, where the reference for progressive disease is the smallest measurements recorded from start of treatment. The proportion of patients with disease control rate will be descriptively reported with 95% binomial confidence interval.
Time frame: Up to 24 weeks
Median overall survival (OS) (Part B)
Median overall survival and 95% confidence interval will be estimated using the Kaplan-Meier method. Duration will be measured from first date of study therapy to date of death from any cause.
Time frame: Up to 2 years
Median duration of response (DOR) (Part B)
Median duration of response will be estimated using Kaplan-Meier product limit method, starting with the date of first scan indicating response until loss of response with disease progression per RECIST version 1.1 or death, whichever occurs first
Time frame: Up to 2 years
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