Phase I Trial of 225Ac-J591 in Patients With mCRPC

• ClinicalTrials.gov Identifier: NCT03276572
• Recruitment Status: Active, not recruiting
• First Posted: September 8, 2017
• Results First Posted: December 6, 2022
• Last Update Posted: December 6, 2022
• Sponsor: Weill Medical College of Cornell University
• Collaborators: Prostate Cancer Foundation; United States Department of Defense; National Institutes of Health (NIH); National Cancer Institute (NCI)
• Information provided by (Responsible Party): Weill Medical College of Cornell University

Study Description

Brief Summary:

This is an open-label, single-center Phase I dose escalation study designed to determine the dose-limiting toxicity (DLT) and the maximum tolerated dose (MTD) of 225Ac-J591 in a single dose regimen.

Condition or disease	Intervention/treatment	Phase
Prostate Cancer	Drug: 225Ac-J591	Phase 1

Detailed Description:

This clinical trial is for men with advanced prostate cancer. The purpose of this study is to find the highest dose level of the study drug, 225Ac-J591 that can be given without severe side effects. The research study is being done because the standard treatments for prostate cancer that has spread beyond the prostate gland are intended to minimize the adverse effects of the disease. These treatments, however, are not curative. Patients who choose to participate in this study will have a screening visit to determine whether or not they are eligible to participate in the study. The treatment phase is comprised of 8 visits over approximately 12 weeks. The study medication is called 225Ac-J591, and participants will receive an infusion of the study drug on the Treatment visit of the study. Upon completion of investigational treatment with single dose of 225Ac-J591, subjects will undergo 68Ga-PSMA-HBED-CC injection and same day PET/CT at the end of study visit to document treatment response. Subsequently survival data and additional treatment(s) information will be captured from their routine Standard of care (SOC) visits.During the other study visits, participants will undergo routine tests and procedures, such as physical examinations, and routine blood tests. Some blood tests will be done for research purposes only. After completion of therapy, participants may be contacted on a periodic basis to see how they are doing.

Key eligibility:

• Open to men age 18 and older.
• Diagnosis of progressive metastatic prostate cancer
• Have been previously treated for their disease with particular types of therapy.

Study Design

• Study Type: Interventional (Clinical Trial)
• Actual Enrollment: 32 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Phase I Dose-Escalation Trial of 225Ac-J591 in Patients With Metastatic Castration-Resistant Prostate Cancer
• Actual Study Start Date: October 10, 2017
• Actual Primary Completion Date: January 7, 2021
• Estimated Study Completion Date: July 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: All Subjects; A single dose of 225Ac-J591 will be given to subjects with documented progressive metastatic CRPC.	Drug: 225Ac-J591; 225Ac-J591 (13.3 KBq/Kg - 93.3 KBq/Kg or 0.36 uCi/Kg - 2.52 uCi/Kg) on day 1; Other Name: 68Ga-PSMA-HBED-CC injection for PET/CT Scan on day 1 and at end of study

Outcome Measures

Primary Outcome Measures :

1. Number of Subjects With Dose Limiting Toxicities (DLT) [ Time Frame: Assessed from start of treatment to up to 8 weeks after first study drug administration. ]
   Count of participants will be measured by the recommended phase II dose in utilizing the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 for DLTs.
2. Number of Subjects Who Reached Maximum Tolerated Dose (MTD) [ Time Frame: Assessed from start of treatment to up to 8 weeks after first study drug administration. ]
   The MTD is the highest dose amongst the different dose-level cohorts in this study at which no more than 2 (33%) of the subjects in a cohort experience DLT.

Secondary Outcome Measures :

1. Number of Subjects With Prostate Specific Antigen (PSA) Response [ Time Frame: PSA was assessed at screening, and up to 6 months after first treatment with study drug. ]
   PSA will be analyzed through blood specimen collection
2. Number of Subjects With Circulating Tumor Cells (CTC) Response [ Time Frame: CTC was assessed at screening and 12 weeks after starting study drug. ]
   CTCs will be analyzed through blood specimen collection via CellSearch methodology lab testing
3. Number of Subjects With Radiographic (Imaging) Response [ Time Frame: Response were assessed for patients throughout their duration on the study, up to 3 years. ]
   Radiographic response rate by Response evaluation criteria in solid tumors (RECIST) criteria with Prostate Cancer Working Group 3 (PCWG3) modifications
4. Progression Free Survival (PFS) [ Time Frame: From the start of treatment to progression, up to 3 years ]
   Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Eligibility Criteria

• Ages Eligible for Study: 18 Years and older (Adult, Older Adult)
• Sexes Eligible for Study: Male
• Gender Based Eligibility: Yes
• Gender Eligibility Description: Adult male patients of >18 years age with documented progressive metastatic CRPC
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Histologically or cytologically confirmed adenocarcinoma of prostate

2. Documented progressive metastatic CRPC based on Prostate Cancer Working Group 3 (PCWG3) criteria, which includes at least one of the following criteria:

   1. PSA progression
   2. Objective radiographic progression in soft tissue
   3. New bone lesions
3. ECOG performance status of 0-2
4. Have serum testosterone < 50 ng/dL. Subjects must continue primary androgen deprivation with an LHRH analogue (agonist/antagonist) if they have not undergone bilateral orchiectomy.

5. Have previously been treated with at least one of the following:

   1. Androgen receptor signaling inhibitor (such as enzalutamide)
   2. CYP 17 inhibitor (such as abiraterone acetate)
6. Have previously received taxane chemotherapy, been determined to be ineligible for taxane chemotherapy by their physician, or refused taxane chemotherapy.
7. Age > 18 years

8. Patients must have normal organ and marrow function as defined below:

   1. Absolute neutrophil count >2,000 cells/mm3
   2. Hemoglobin ≥9 g/dL
   3. Platelet count >150,000 x 109/microliter
   4. Serum creatinine <1.5 x upper limit of normal (ULN) or calculated creatinine clearance ≥ 60 mL/min/1.73 m2 by Cockcroft-Gault
   5. Serum total bilirubin <1.5 x ULN (unless due to Gilbert's syndrome in which case direct bilirubin must be normal
   6. Serum AST and ALT <3 x ULN in absence of liver metastases; <5x ULN if due to liver metastases (in both circumstances, bilirubin must meet entry criteria)
9. Ability to understand and the willingness to sign a written informed consent document.

Exclusion Criteria:

1. Implantation of investigational medical device ≤4 weeks of Cycle 1, Day 1 or current enrollment in oncologic investigational drug or device study
2. Use of investigational drugs ≤4 weeks or <5 half-lives of Cycle 1, Day 1 or current enrollment in investigational oncology drug or device study
3. Prior systemic beta-emitting bone-seeking radioisotopes
4. Known active brain metastases or leptomeningeal disease
5. History of deep vein thrombosis and/or pulmonary embolus within 1 month of C1D1
6. Other serious illness(es) involving the cardiac, respiratory, CNS, renal, hepatic or hematological organ systems which might preclude completion of this study or interfere with determination of causality of any adverse effects experienced in this study
7. Radiation therapy for treatment of PC ≤4 weeks of Day 1 Cycle 1
8. Patients on stable dose of bisphosphonates or Denosumab, which have been started no less than 4 weeks prior to treatment start, may continue on this medication, however patients are not allowed to initiate bisphosphonate/Denosumab therapy during the DLT-assessment period of the study.
9. Having partners of childbearing potential and not willing to use a method of birth control deemed acceptable by the principle investigator and chairperson during the study and for 1 month after last study drug administration
10. Currently active other malignancy other than non-melanoma skin cancer. Patients are considered not to have "currently active" malignancy if they have completed any necessary therapy and are considered by their physician to be at less than 30% risk of relapse.
11. Known history of known myelodysplastic syndrome

Contacts and Locations

Locations

United States, Louisiana

Tulane Cancer Center Clinic

New Orleans, Louisiana, United States, 70112

United States, New York

Weill Cornell Medical College

New York, New York, United States, 10065

Sponsors and Collaborators

Weill Medical College of Cornell University

Prostate Cancer Foundation

United States Department of Defense

National Institutes of Health (NIH)

National Cancer Institute (NCI)

Investigators

• Principal Investigator: Scott Tagawa, MD; Weill Medical College of Cornell University

  Study Documents (Full-Text)

Documents provided by Weill Medical College of Cornell University:

Study Protocol and Statistical Analysis Plan  [PDF] August 30, 2021

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Vlachostergios PJ, Niaz MJ, Skafida M, Mosallaie SA, Thomas C, Christos PJ, Osborne JR, Molina AM, Nanus DM, Bander NH, Tagawa ST. Imaging expression of prostate-specific membrane antigen and response to PSMA-targeted beta-emitting radionuclide therapies in metastatic castration-resistant prostate cancer. Prostate. 2021 Apr;81(5):279-285. doi: 10.1002/pros.24104. Epub 2021 Jan 19.

• Responsible Party: Weill Medical College of Cornell University
• ClinicalTrials.gov Identifier: NCT03276572
• Other Study ID Numbers: 1706018281; 7R01CA207645-03 ( U.S. NIH Grant/Contract )
• First Posted: September 8, 2017
• Results First Posted: December 6, 2022
• Last Update Posted: December 6, 2022
• Last Verified: November 2022

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: No

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

Additional relevant MeSH terms:

Prostatic Neoplasms; Genital Neoplasms, Male; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Genital Diseases, Male; Genital Diseases; Urogenital Diseases; Prostatic Diseases; Male Urogenital Diseases; Gallium 68 PSMA-11; Radiopharmaceuticals; Molecular Mechanisms of Pharmacological Action