Lenalidomide and GM-CSF in Treating Patients With Prostate Cancer

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
Robert Dreicer MD, Case Comprehensive Cancer Center
ClinicalTrials.gov Identifier:
NCT00939510
First received: July 14, 2009
Last updated: January 24, 2013
Last verified: January 2013
  Purpose

RATIONALE: Lenalidomide may stop the growth of prostate cancer by blocking blood flow to the tumor. GM-CSF may stimulate the immune system in different ways and stop tumor cells from growing. Giving lenalidomide together with GM-CSF may kill more tumor cells.

PURPOSE: This phase I/II trial is studying the side effects and best dose of lenalidomide when given together with GM-CSF and to see how well it works in treating patients with prostate cancer.


Condition Intervention Phase
Prostate Cancer
Biological: sargramostim
Drug: lenalidomide
Other: laboratory biomarker analysis
Phase 1
Phase 2

Study Type: Interventional
Study Design: Endpoint Classification: Safety/Efficacy Study
Intervention Model: Single Group Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Phase I/II Study of Lenalidomide (RevlimidTM ) and GM-CSF in Androgen Independent Prostate Cancer

Resource links provided by NLM:


Further study details as provided by Case Comprehensive Cancer Center:

Primary Outcome Measures:
  • Number of Patients With a PSA Response [ Time Frame: reevaluated for response every eight weeks ] [ Designated as safety issue: No ]
    Number of patients with a PSA Response defined as a PSA decline greater or equal to 50% compared with baseline value.

  • RECIST-defined Measurable Disease [ Time Frame: every 8 weeks and at end of treatment ] [ Designated as safety issue: No ]
    Patients who have a response of Complete Response (CR), Partial Response (PR), or Stable Disease (SD) by RECIST criteria. To be assigned a status of PR or CR, changes in tumor measurements must be confirmed by repeat assessments that should be performed no less than 4 weeks after the criteria for response are first met. In the case of SD, follow-up measurements must have met the SD criteria at least once after study entry at a minimum interval of 6-8 weeks


Secondary Outcome Measures:
  • Number of Patients With Statistically Significant Change in Immune Response From Baseline to End of Study [ Time Frame: every 28 days for first 3 cycles, end of study ] [ Designated as safety issue: No ]
    The change in mean T cell immunohistochemical markers and dendritic cells over time will be evaluated using analysis of variance methods for repeated measures with additional main factors included in the analysis for subset comparisons. The pattern of immune response will be evaluated based upon overall clinical response using these same techniques.


Enrollment: 32
Study Start Date: July 2005
Study Completion Date: December 2012
Primary Completion Date: October 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Lenalidomide (RevlimidTM ) and GM-CSF Biological: sargramostim
All patients will receive GM-CSF at a dose of 250 mcg subcutaneously on Mondays, Wednesdays and Fridays every week. No dose escalation or de-escalations will be made to GM-CSF.
Other Name: GM-CSF
Drug: lenalidomide
Lenalidomide will be administered at 25 mg/day orally on days 1-21 of a 28-day cycle. Initially 6 patients will be entered at the 25 mg/day level. If 0 or 1 patients have a dose limiting toxicity, then the 25 mg lenalidomide + GM-CSF 250 mcg subcutaneously on Mondays, Wednesdays and Fridays every week will be accepted as the phase II dose.
Other: laboratory biomarker analysis
Prior to the initiation of each cycle of therapy for the first 3 cycles, and at discontinuation from study blood will be collected for assessments of a prostate cancer specific immune response.

Detailed Description:

OBJECTIVES:

  • Establish the safety of a predetermined target dose or, if the target dose is not tolerable, find the maximum tolerated dose of lenalidomide when administered in combination with sargramostim in patients with androgen-independent prostate cancer.
  • Evaluate the preliminary efficacy of this regimen to ascertain whether additional study of lenalidomide is warranted in patients with androgen-independent prostate cancer.
  • Evaluate the safety of this regimen in these patients.
  • Describe the effects of this regimen on serum cytokines (e.g., TNF-α, bFGF, sIL2R, IL-8, and IL-12) and on serum VEGF levels.
  • Assess the co-stimulatory effects of this regimen on CD4+, CD8+, CD83, and CD86 cells.

OUTLINE: This is a phase I, dose-escalation study of lenalidomide followed by a phase II study.

Patients receive oral lenalidomide on days 1-21 and sargramostim subcutaneously on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Blood samples are collected periodically for correlative biomarker and immunological laboratory studies.

After completion of study therapy, patients are followed up at 30 days and then every 3 months thereafter.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Male
Accepts Healthy Volunteers:   No
Criteria

DISEASE CHARACTERISTICS:

  • Histologically confirmed adenocarcinoma of the prostate
  • Androgen-independent disease

    • Testosterone ≤ 50 ng/mL

      • Is currently receiving luteinizing hormone-releasing hormone agonists as maintenance or has undergone prior orchiectomy for testosterone suppression
  • Progressive disease, as defined by ≥ 1 of the following:

    • Clinical or radiographic evidence of metastases that have progressed irrespective of PSA changes
    • Asymptomatic (non-opioid requiring) bone-only metastatic disease with a rising PSA on separate measurements ≥ 1 week apart

      • No symptomatic bone metastases
    • Biochemical progression (PSA-only disease), defined as having an absolute PSA value of ≥ 2.0 ng/mL on 3 separate measurements ≥ 2 weeks apart with a PSA doubling time of ≤ 10 months
  • No evidence of CNS (brain or leptomeningeal) metastases or pleural and/or pericardial effusions

PATIENT CHARACTERISTICS:

  • ECOG performance status of 0-1
  • ANC ≥ 1,500/mm^3
  • Platelet count ≥ 100,000/mm^3
  • Serum creatinine ≤ 2.0 mg/dL
  • AST < 3 times normal
  • Bilirubin < 1.5 mg/dL
  • PT and PTT normal
  • Calcium normal
  • Fertile patients must use effective contraception during and for ≥ 28 days after completion of study therapy
  • Agrees to abstain from donating blood, semen, or sperm during and for ≥ 28 days after completion of study therapy
  • No pre-existing peripheral neuropathy > grade 1
  • No active unresolved infection
  • No known contraindication to lenalidomide or sargramostim
  • No other malignancies within the past 5 years, except for curatively treated basal cell or squamous cell carcinoma of the skin or stage Ta transitional cell carcinoma of the bladder

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior chemotherapy for metastatic prostate cancer
  • More than 1 year since prior adjuvant and/or neoadjuvant therapy
  • More than 4 weeks since prior flutamide (6 weeks for other antiandrogens)
  • No prior thalidomide or lenalidomide
  • At least 4 weeks since prior surgery or external-beam radiotherapy and recovered
  • At least 6 weeks since prior radiopharmaceutical therapy, including samarium-153 or strontium-89, and recovered
  • No initiation of bisphosphonate therapy within 1 month before and during study therapy

    • Patients on stable doses of bisphosphonates who show subsequent tumor progression may continue to receive bisphosphonates
  • Concurrent daily aspirin for the prevention of thrombotic events required

    • Patients intolerant to aspirin may receive low-dose warfarin as prophylaxis
  • No other concurrent investigational agents
  • No other concurrent anticancer therapy, including radiotherapy or thalidomide
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00939510

Locations
United States, Ohio
Cleveland Clinic Taussig Institute, Case Comprehensive Cancer Center
Cleveland, Ohio, United States, 44195
Sponsors and Collaborators
Robert Dreicer MD
Investigators
Principal Investigator: Robert Dreicer, MD, FACP Cleveland Clinic Taussig Cancer Institute, Case Comprehensive Cancer Center
  More Information

Additional Information:
No publications provided

Responsible Party: Robert Dreicer MD, Principal Investigator, Case Comprehensive Cancer Center
ClinicalTrials.gov Identifier: NCT00939510     History of Changes
Other Study ID Numbers: CASE3805, P30CA043703, IRB# 8121, RV-PCA-PI-059
Study First Received: July 14, 2009
Results First Received: April 26, 2012
Last Updated: January 24, 2013
Health Authority: United States: Food and Drug Administration

Keywords provided by Case Comprehensive Cancer Center:
adenocarcinoma of the prostate
hormone-resistant prostate cancer
recurrent prostate cancer
stage IV prostate cancer

Additional relevant MeSH terms:
Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Lenalidomide
Thalidomide
Antineoplastic Agents
Therapeutic Uses
Pharmacologic Actions
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Leprostatic Agents
Anti-Bacterial Agents
Anti-Infective Agents
Angiogenesis Inhibitors
Angiogenesis Modulating Agents
Growth Substances
Growth Inhibitors

ClinicalTrials.gov processed this record on April 16, 2014