This phase II trial tests how well pertuzumab, trastuzumab, hyaluronidase-zzxf and enzalutamide works in treating patients with castration-resistant prostate cancer that has spread from where it first started to other places in the body (metastatic). Pertuzumab and trastuzumab are monoclonal antibodies and forms of targeted therapy that attach to a receptor protein called human epidermal growth factor receptor-2 (HER2). HER2 is found on some cancer cells. When pertuzumab or trastuzumab attach to HER2, the signals that tell the cells to grow are blocked and the tumor cell may be marked for destruction by the body's immune system. Hyaluronidase is an endoglycosidase. It helps to keep pertuzumab and trastuzumab in the body longer, so that these medications will have a greater effect. Hyaluronidase also allows pertuzumab and trastuzumab to be given by injection under the skin and shortens their administration time compared to pertuzumab or trastuzumab alone. Chemotherapy drugs, such as enzalutamide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving pertuzumab, trastuzumab, hyaluronidase-zzxf and enzalutamide may kill more cancer cells.
PRIMARY OBJECTIVE: I. Evaluate the preliminary efficacy of the combination of pertuzumab, trastuzumab, and hyaluronidase-zzxf plus enzalutamide with regard to objective response rate (Prostate Cancer Clinical Trials Working Group 3 \[PCWG 3.0\]) in enzalutamide-refractory metastatic castration-resistant prostate cancer. SECONDARY OBJECTIVES: I. Estimate the radiographic progression-free survival for this combination. II. Estimate the overall survival for this combination. EXPLORATORY OBJECTIVES: I. Assessment of this combination for adverse events according to clinical judgment and patient-reported outcomes (Patient Reported Outcomes-Common Terminology Criteria for Adverse Events \[PRO-CTCAE\] - Prostate Cancer). II. Assessment of patient quality of life using Functional Assessment of Cancer Therapy- Prostate (FACT-P) questionnaire. CORRELATIVE OBJECTIVES: I. Determine the correlation between outcomes as above and systemic NRG-1 levels at baseline and over time. II. Determine the correlation between outcomes as above and change in HER2/HER3/androgen receptor (AR) gene signatures. OUTLINE: Patients receive pertuzumab, trastuzumab, and hyaluronidase-zzxf subcutaneously (SC) on day 1 of each cycle and enzalutamide orally (PO) once daily (QD) on days 1-21 of each cycle. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO), biopsy, computed tomography (CT), and magnetic resonance imaging (MRI) scans and collection of blood samples throughout the study. After completion of study treatment, patients are followed up every 3 months until progressive disease then every 6 months thereafter.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
7
Undergo biopsy
Undergo collection of blood and tissue samples
Undergo CT
Undergo ECHO
Given PO
Given SC
Undergo MRI
Ancillary studies
Mayo Clinic in Arizona
Scottsdale, Arizona, United States
Mayo Clinic in Florida
Jacksonville, Florida, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Overall Response Rate (ORR)
ORR is defined as the percentage of patients who experience either a partial response or complete response as defined by Prostate Cancer Working Group 3 (PCWG3). Overall Response per Prostate Cancer Working Group 3 (PCWG3) is a composite assessment integrating soft-tissue disease evaluated by RECIST v1.1 and bone disease evaluated separately using PCWG3 bone scan criteria. Complete Response (CR) is disappearance of all soft-tissue target lesions (with lymph nodes \<10 mm short axis) and no bone progression; Partial Response (PR) is a ≥30% decrease in the sum of diameters of soft-tissue target lesions with no bone progression; Stable Disease (SD) is neither CR/PR nor Progressive Disease. Progressive Disease (PD) is declared by radiographic progression in either domain, defined as RECIST v1.1 progression or confirmed bone progression using the PCWG3 2+2 rule for new bone lesions, regardless of PSA changes.
Time frame: Up to 1 year
Progression-free Survival (PFS)
PFS is defined as the time from study entry to the first of either confirmed radiographic disease progression or death from any cause, determined based on Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria.
Time frame: Up to 1 year
Overall Survival (OS)
OS is defined as the time from study entry to death from any cause.
Time frame: Up to 1 year
Number of Participants With Treatment-related Grade 3 or Higher Adverse Event
The rate of patients experiencing any Grade 3 or higher adverse event \> deemed at least possibly related to treatment will be reported. The maximum grade for each type of adverse event by patient will also be \> summarized by frequencies and percentages using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Time frame: Up to 1 year
Change in Quality of Life (QoL) From Baseline
Assessed using the Functional Assessment of Cancer Therapy - Prostate (FACT-P), a 39-item questionnaire that measures quality of life (QOL) in men with prostate cancer. Questions are answered on a scale of 0-4 where 0=not at all; 1=a little bit; 2=somewhat; 3=quite a bit; and 4=very much. FACT-P is composed of five subscales: Physical Well-Being (7 items; score range 0-28), Social/Family Well-Being (7 items; 0-28), Emotional Well-Being (6 items; 0-24), Functional Well-Being (7 items; 0-28), and the Prostate Cancer Subscale (12 items; 0-48). Subscale scores are summed to compute a total FACT-P score ranging from 0 to 156, with higher scores indicating better quality of life and lower scores indicating worse quality of life. Patient responses to the FACT-P will be summarized descriptively by the change in FACT-P score from baseline at last assessment. .
Time frame: Up to 1 year
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