This research is being done to determine if receiving the combination of testosterone and ZEN-3694 followed by the combination of enzalutamide plus ZEN-3694 will decrease the size of tumors in patients with prostate cancer that has become resistant to castration and other therapies. The investigators also want to determine if dosing first with the combination of testosterone and ZEN-3694 may cause enzalutamide and ZEN-3694 to work more effectively.
The primary objectives of the study are first to determine if treatment with the combination of ZEN-3694 and Bipolar Androgen Therapy (i.e. BATZEN) will improve the progression-free survival in patients with metastatic castrate-resistant prostate cancer (mCRPC) compared with historical controls. The second primary objective is to determine if treatment with ZEN-3694 and Enzalutamide (i.e. ZENZA) after progression on Bipolar Androgen Therapy (BAT) will improve PSA-progression-free survival compared to historical controls. Asymptomatic patients with mCRPC without pain due to prostate cancer will be treated on an open label study to evaluate effectiveness of sequential treatment with the combination of ZEN-3694 and high dose testosterone in sequence with enzalutamide and ZEN-3694 to improve primary and secondary outcomes. Eligible patients are those with mCRPC who have progressive disease after treatment with a second-generation AR-axis inhibitor (Abiraterone, Enzalutamide, Darolutamide, or Apalutamide) used as treatment for castration-sensitive or castration-resistant disease. Patients will continue on Androgen Deprivation Therapy (ADT) with LHRH agonist (i.e. Zoladex, Trelstar, Eligard, or Lupron) or LHRH antagonist (Degarelix or Relugolix) if not surgically castrated throughout the duration of the study to inhibit endogenous testosterone production. One cycle of treatment will be 28 days.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
One ZEN-3694 pill (48 mg) will be taken each day of each BATZEN cycle.
On day 1 of each BATZEN cycle testosterone cypionate (400 mg) injection to the buttocks will be administered.
Enzalutamide 160 mg (four 40 mg capsules) taken daily by mouth on each ZENZA cycle.
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
Baltimore, Maryland, United States
RECRUITINGClinical/radiographic progression free survival (PFS) with BATZEN
Median time from the first date of BATZEN to the date of first documented radiological progression per RECIST 1.1 for soft tissue or per Prostate Cancer Working Group 3 (PCWG3) for bone lesions, the development of symptoms or complications attributable to cancer progression, or death, whichever occurs first.
Time frame: 2 years
Prostate specific antigen (PSA)-Progression free survival (PFS) with ZENZA
PSA-PFS on ZENZA is the median time from start of ZENZA to time of PSA progression according to PCWG3 criteria ,or censored at the last date of PSA assessment for patients without PSA progression.
Time frame: 2 years
Number of participants with PSA 50 (≥50% PSA reduction) response to BATZEN
Number of participants with ≥50% PSA reduction from baseline level at screening.
Time frame: 2 years
Number of participants with PSA50 response to ZENZA
Number of participants with ≥50% PSA reduction from PSA level at time of progression on BATZEN
Time frame: 2 years
Time to PSA progression while on BATZEN
Median time (months) from start of BATZEN to date of PSA progression on ZENZA
Time frame: 2 years
Number of participants with Objective response to BATZEN and ZENZA, respectively per RECIST 1.1 criteria
The number of participants with measurable disease who achieve either complete response or partial response to per RECIST 1.1
Time frame: 2 years
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50
Patients will continue on ADT with LHRH agonist (i.e. Zoladex, Trelstar, Eligard or Lupron) or LHRH antagonist (Degarelix or Relugolix) if not surgically castrated throughout the duration of the study to inhibit endogenous testosterone production.
Progression Free Survival (PFS2) (PSA progression on ZENZA)
Median time from start of BATZEN to date of PSA progression on ZENZA
Time frame: 2 years
Overall Survival
Number of months from start of study therapy to death from any cause.
Time frame: 5 years
Quality of Life as assessed by the Functional Assessment of Chronic Illness Therapy (FACIT) - Fatigue Scale
Quality of life over time based on the FACIT-Fatigue. The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue) is a 13-item measure that assesses self-reported fatigue and its impact upon daily activities and function. The total score ranges between 0 and 52, with higher scores denoting less fatigue.
Time frame: 1 year
Quality of Life as assessed by the Short Form-36 (SF-36)
Quality of life over time based on the SF-36 survey. Short Form 36 (SF-36) is a set of generic, coherent, and easily administered quality-of-life measures. Score range 0-100, lower scores represent more physical function disability, while higher scores represent less disability.
Time frame: 1 year
Number of participants with treatment-related adverse events
Measured by the number of participants with treatment-related adverse events as assessed by the Common Terminology Criteria for Adverse Events (CTCAE) v5.0
Time frame: 2 years