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Oral Calcitriol With Ketoconazole in CRPC

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ClinicalTrials.gov Identifier: NCT03261336
Recruitment Status : Terminated (can not meet enrollment)
First Posted : August 25, 2017
Last Update Posted : March 2, 2018
Sponsor:
Information provided by (Responsible Party):
Donald Trump, MD, Inova Health Care Services

Brief Summary:
The aim of this study is to estimate the PSA response rate with the use of ketoconazole (400mg QD + hydrocortisone 20mg AM, 10 mg PM) among men with CRPC in whom disease has progressed despite abiraterone

Condition or disease Intervention/treatment Phase
Castration-resistant Prostate Cancer Drug: Calcitriol, Ketoconazole, Hydrocortisone Phase 2

Detailed Description:

This study will aim to describe objective tumor responses to the combination of oral calcitriol and ketoconazole and hydrocortisone-among patients with measurable disease using modified RECIST 1.1 criteria.

Additionally, we will determine toxicities, and tolerability of oral calcitriol combination with daily oral ketoconazole, and hydrocortisone in this patient population.

this is a single arm phase II trial of ketoconazole (400mg QD + hydrocortisone 20mg AM, 10 mg PM) among men with CRPC in whom disease has progressed despite abiraterone


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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 1 participants
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Intervention Model Description: Calcitriol 10mcg QD X3, weekly + Ketoconazole 400mg po TID and Hydrocortisone 20mg AM, 10mg PM
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Phase II Study of Oral Calcitriol in Combination With Ketoconazole in Castration Resistant Prostate Cancer, Progressing Despite Primary ADT and Abiraterone
Actual Study Start Date : January 6, 2017
Actual Primary Completion Date : February 28, 2018
Actual Study Completion Date : February 28, 2018


Arm Intervention/treatment
Experimental: Calcitriol, Ketoconazole, Hydrocortisone
Patients receive calcitriol (10mcg QD X3 weekly) in addition to ketoconazole (400mg QD) and hydrocortisone (20mg AM, 10 mg PM).
Drug: Calcitriol, Ketoconazole, Hydrocortisone
Calcitriol (0.5 mcg caplets) given in escalating doses, orally QD X3 consecutive days every week Ketoconazole, 200 mg tablets, 2 tablets orally TID Hydrocortisone 20mg AM, 10mg PM orally starting in the evening before the first dose of Calcitriol
Other Names:
  • Rocaltrol®
  • active form of vitamin D3




Primary Outcome Measures :
  1. PSA response rate [ Time Frame: 2 years ]
    Assessment of PSA every 4 weeks


Secondary Outcome Measures :
  1. Tumor response [ Time Frame: 2 years ]
    Objective tumor response among patients with measurable disease using modified RECIST1.1

  2. Toxicity and tolerability of experimental arm [ Time Frame: 2 years ]
    Descriptive analysis of observed toxicity and patient reports of tolerating experimental treatment



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria

For inclusion in the trial, a patient must fulfill all of the following criteria:

  1. Greater than or equal to 18 years of age. The effects of ketoconazole and high-dose calcitriol have not been studied adequately in patients <18 years of age and prostate cancer has not been described in children.
  2. Histologically or cytologically confirmed adenocarcinoma consistent clinically with androgen Independent prostate cancer
  3. Measurable disease with elevated PSA or evaluable disease (PSA elevation will constitute evaluable disease).
  4. No cytotoxic chemotherapy for extensive disease prior to study entry will be allowed; given the recent data regarding the role of docetaxel + ADT in patients beginning ADT for advanced disease, such "adjuvant chemotherapy will be allowed (no more than 6 cycles) retinoids, vitamin D analogues, PPAR agonists or antagonists, antiandrogens, progestational agents, estrogens, PC-SPES, LHRH analogues, vaccines, cytokines will not be considered "cytotoxics." Patients who have previously received ketoconazole + glucocorticoids will NOT be eligible for this trial.
  5. Patients who have received antiandrogens or progestational agents as therapy for prostate cancer must discontinue therapy and demonstrate a rising PSA > 28 days following discontinuation (antiandrogen withdrawal - AAW) (>42 days for bicalutamide or nilutamide). Patients who receive megestrol acetate as therapy for "hot flashes" at a dose of <40mg per day may continue this therapy during this trial. The dose of the megestrol acetate should not be changed during protocol treatment. Patients undergoing androgen deprivation using LHRH analogues must continue such agents or undergo orchiectomy to maintain castrate levels of testosterone.
  6. Patients must have prostate cancer that is advanced or recurrent.
  7. Patients should not have received any chemotherapy or investigational agents for at least 28 days before entering the study.
  8. Eastern Clinical Oncology Group performance status 0 or 1
  9. Life expectancy >3 months.
  10. Patients must have normal organ and marrow function as defined below:

    leukocytes: >3,000/μl hemoglobin: > 8 g/dl absolute neutrophil count (ANC):>1,500/μl platelets: >75,000/μl total bilirubin: within normal institutional limit AST/ALT: <2.5 X institutional upper limit of normal creatinine: < 2mg/dL calcium: not above normal institutional limit

  11. Patients should be able to receive oral medications.
  12. Patients with brain metastases which are stable and have been treated with surgery and/or irradiation will be eligible for this trial.
  13. The effects of high-dose calcitriol and ketoconazole on the developing human fetus are unknown. For this reason and because these agents as well are known to be teratogenic, men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform the treating physician immediately.
  14. Ability to understand and the willingness to sign a written informed consent document.
  15. Progressive disease must have occurred on abiraterone within the prior 12 months and patient must not have received treatment with enzalutamide.

Men of all ethnic groups are eligible for this trial. Efforts will be made to include minority groups and all representative ethnicities and races in the community.

Exclusion Criteria

Any of the following is a criterion for exclusion from the trial:

  1. Known severe hypersensitivity to ketoconazole, calcitriol or any of the excipients of these products.
  2. History of allergic reactions attributed to compounds of similar chemical or biologic composition to calcitriol, ketoconazole, or other agents used in study.
  3. Evidence of any other significant clinical disorder or laboratory finding that makes it undesirable for the patient to participate in the trial.
  4. History of kidney, ureteral, or bladder stones within the last 5 years
  5. Heart failure or significant heart disease including significant arrhythmias, myocardial infarction within the last 3 months, unstable angina, documented ejection fraction <30%, or current digoxin therapy.
  6. Thiazide therapy within 7 days from entering the study.
  7. Requirement for concurrent systemic glucocorticoid therapy at greater than physiologic replacement doses
  8. Unwillingness to stop calcium supplementation.
  9. As judged by the investigator, any evidence of severe or uncontrolled systemic disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal disease) or intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
  10. Human immunodeficiency virus-positive patients receiving combination anti-retroviral therapy are excluded from the study because of possible PK interactions with ketoconazole or other agents administered during the study. Appropriate studies will be undertaken in patients receiving combination anti-retroviral therapy when indicated.
  11. Concomitant use of phenytoin, carbamazepine, barbiturates, rifampicin, phenobarbital, or St John's wort, alfentanil, alfuzosin, almotriptan, alprazolam, amiodarone, amitriptyline, amprenavir, aprepitant, aripiprazole, bepridil, bortezomib, bosentan, budesonide, buprenorphine, buspirone, carbamazepine, cilostazol, cisapride, cyclosporine, delavirdine, didanosine, digoxin, disopyramidedofetilide, donepezil, eletriptan, eplerenone, fluticasone, fosamprenavir, galantamine, systemic griseofulvin, indinavir, levobupivacaine, lopinavir, midazolam, mifepristone, modafinil, nateglinide, nefazadone, nelfinavir, oxcarbazepine, pimozide, quetiapine, quinidine, repaglinide, rifabutin, rifampin, rifapentine, ritonavir, saquinavir, sildenafil, sirolimus, tacrolimus, tadalafil, tolterodine, theophyllines, tolterodine, triazolam, valdecoxib, vardenafil, ziprasidone, zonisamide, statins, with the exception of pravastatin (Pravachol) or other "statins" which are not metabolized by or induce CYP3A4, calcium channel blockers, and macrolides or other agents that will be significantly perturbed in a clinically important way by the P450 inhibitory properties of ketoconazole
  12. Concomitant use of proton pump inhibitors or H2 blockers
  13. Treatment with a non-approved or investigational drug or agent within 28 days before day 1 of trial treatment.
  14. Any unresolved chronic toxicity greater then CTC Grade 2 from previous anticancer therapy.
  15. Incomplete healing from previous oncologic treatments or other major surgery.
  16. Inability to swallow oral capsules.
  17. Patients on digoxin will be excluded from this study.

Products Dosage and Mode of Administration

  • Ketoconazole, 200 mg tablets, 2 tablets orally TID
  • Calcitriol (0.5 mcg caplets) given in escalating doses, orally QD X3 consecutive days every week
  • Hydrocortisone 20mg AM, 10mg PM orally starting in the evening before the first dose of Calcitriol.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03261336


Locations
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United States, Virginia
Inova Schar Cancer Institute
Fairfax, Virginia, United States, 22031
Sponsors and Collaborators
Donald Trump, MD
Investigators
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Principal Investigator: Skip (Donald) Trump, MD CEO & Executive Director Inova Schar Cancer Institute

Publications:
McElwain MC, Dettlebach MA, Modzelewski RA, et al. Antiproliferative effects in vitro and in vivo of 1,25-dihydroxyvitamin D3 and a vitamin D3 analog in a squamous cell carcinoma model system Mol Cell Diff 3 (1) 31 (1995).
Modzelewski RA. Apoptotic effects of paclitaxel and calcitriol in rat dunning MLL and human PC-3 prostate tumor cells in vitro. Proc Amer Assoc Cancer Res 40 580, 1999.
McGuire TF, Trump DL and Johnson CS. 1,25-dihydroxyvitamin D3 induces cytosolic accumulation of MEKK-1 before onset of apoptosis in a p38 MAPK-regulated manner. Proc. Amer. Assoc. Cancer Res. 2159, 435 (2002).
Johnson CS, Egorin MJ, Zuhowski R, 35 al. Effects of high dose calcitriol (1,25 dihydroxyvitamin D3) on the pharmacokinetics of paclitaxel or carboplatin: results of two phase I studies Amer Soc Clin Oncol 19 210a (2000).
Muindi JR, Modzelewski RA, Peng Y, Hershberger PA, Trump DL and Johnson CS. Plasma 1, 25-dihydroxycholecalciferol pharmacokinetics in normal and tumor bearing mice. Oncology (in press).
Hershberger PA, Modzelewski RA, Rueger RM, Blum KE, Trump DL, and Johnson CS. Enhanced anti-tumor efficacy with dexamethasone/calcitriol/cisplatin therapy: role of P21WAF1. Proc. Amer. Assoc. Cancer Res. 41, 15 (2000).
Yu WD, Rueger RM, Fuller RW, Johnson CS, and Trump DL. 1,25-dihydroxycholecalciferol (calcitriol) enhancement of chemotherapeutic efficacy: synergistic effects by median dose effect. Proc. Amer. Assoc. Cancer Res. 42, 84 (2001).
Trump DL, Serafine S, Brufsky J, et al. High dose calcitriol (1,25(OH)2 vitamin D3) + dexamethasone in androgen independent prostate cancer (AIPC). Amer Soc Clin Oncol 19 337a (2000).
Haynes RC. Agents affecting calcification: calcium, parathyroid hormone, calcitonin, vitamin D, and other compounds. The Pharmacological Basis of Therapeutics. Gilman AG, Rall TW, Nies AS, Taylor P (eds). New York Pergamon Press 1496 (1990).
Small EJ, Marshall ME, Reyno L, et al. Superiority of suramin plus hydrocortisone over placebo plus hydrocortisone: results of a multicenter, double-blind, phase II study in patients with hormone refractory prostate cancer. J Clin Oncol 17 308 (1998).
Davies M. High-dose vitamin D therapy: Indications, benefits and hazards. IN: Elevated Dosages of vitamins. P Walter, G Brubacher, H Stahelin (eds) Hans Humber, Lewistown, NY 81 (1989).
Beer TM, Eilers KM, Garzotto M, et al. Androgen-independent prostate Cancer (AIPC) treatment with weekly high-dose calcitriol and docetaxel. Amer Soc Clin Oncol 21 177a (2002).

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Responsible Party: Donald Trump, MD, CEO & Executive Director, Inova Schar Cancer Institute, Inova Health Care Services
ClinicalTrials.gov Identifier: NCT03261336     History of Changes
Other Study ID Numbers: 16-2200
First Posted: August 25, 2017    Key Record Dates
Last Update Posted: March 2, 2018
Last Verified: February 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: Yes
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
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Prostatic Neoplasms
Genital Neoplasms, Male
Urogenital Neoplasms
Neoplasms by Site
Neoplasms
Genital Diseases, Male
Prostatic Diseases
Hydrocortisone
Hydrocortisone 17-butyrate 21-propionate
Hydrocortisone acetate
Hydrocortisone hemisuccinate
Ketoconazole
Calcitriol
Anti-Inflammatory Agents
Antifungal Agents
Anti-Infective Agents
14-alpha Demethylase Inhibitors
Cytochrome P-450 Enzyme Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Steroid Synthesis Inhibitors
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Cytochrome P-450 CYP3A Inhibitors
Calcium-Regulating Hormones and Agents
Calcium Channel Agonists
Membrane Transport Modulators
Vasoconstrictor Agents
Vitamins