This study has been transitioned to CTIS with ID 2023-506365-64-00 check the CTIS register for the current data. The purpose of this study is to investigate if niraparib added to a standard treatment (consisting of abiraterone acetate plus…
ID
Source
Brief title
Condition
- Prostatic disorders (excl infections and inflammations)
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
• To determine if niraparib, AA plus prednisone compared with AA plus
prednisone in participants with deleterious germline or somatic HRR
gene-mutated mCSPC provides superior radiographic progression-free survival
(rPFS).
Secondary outcome
• To assess the clinical benefit of niraparib and AA plus prednisone compared
with AAP in participants with deleterious germline or somatic HRR gene-mutated
mCSPC.
• To characterize the safety profile of niraparib and AA plus prednisone
compared with AAP in participants with deleterious germline or somatic HRR
gene-mutated mCSPC.
Background summary
There are several options to treat patients with metastatic prostate cancer.
One of the options is treatment with medicines that work in a very specific
way. It must therefore first be investigated how (with which type of potential
medication) your prostate cancer could be treated best. Niraparib is a type of
anticancer medicine called a PARP inhibitor. PARP helps cells repair damaged
DNA. By inhibiting PARP, the damaged DNA in cancer cells cannot be repaired,
especially in cells with other known DNA repair gene defects (DRD). This leads
to death of cancer cells and thus helps to control the cancer.
In this study, in patients with castration sensitive prostate cancer with a
known DNA repair gene defect, the combination of niraparib and abiraterone
acetate plus prednisone (AA-P) will be compared to AA-P alone. The combination
therapy may be more effective for patients with DNA repair defects than AA-P
alone, as they generally have worse response to standard of care therapies than
other patients.
Recent studies have demonstrated the efficacy of combining a PARP inhibitor
with existing therapy (with abiraterone acetate) plus prednisone in men with
metastatic castration resistant prostate cancer. Incidentally, niraparib is
already registered in the Netherlands (called Zejula®) and it is used for
treatment of certain other kinds of cancers and abiraterone acetate is also
registered in The Netherlands (called ZYTIGA®) and it is used with prednisone
for the treatment of metastatic prostate cancer.
Study objective
This study has been transitioned to CTIS with ID 2023-506365-64-00 check the CTIS register for the current data.
The purpose of this study is to investigate if niraparib added to a standard
treatment (consisting of abiraterone acetate plus prednisone) will work better
than abiraterone acetate and prednisone alone in treating men with metastatic
prostate cancer with specific genetic changes.
Study design
This is a randomized, placebo-controlled, double-blind, multinational Phase 3
study to evaluate the safety and efficacy of niraparib, and AAP, and prednisone
compared with AAP in men over the age of 18 years with deleterious germline or
somatic HRR gene-mutated mCSPC.
Approximately 788 participants will be randomly assigned on a 1:1 basis to
either niraparib 200 mg, AA 1000 mg plus prednisone 5 mg daily or AA 1000 mg
plus prednisone 5 mg daily. All participants must be receiving background
androgen deprivation therapy (ADT; ie, gonadotropin-releasing hormone analogue
or surgical castration).
The study will consist of 4 phases; a Prescreening Phase for biomarker
evaluation for eligibility only, a Screening Phase, a Treatment Phase, and a
Follow-up Phase.
Efficacy, safety, pharmacokinetics (PK), and biomarkers will be assessed
according to the Schedule of Activities (SoA).
Administration of the study medicines is continuous; however, a cycle is
defined as 28 days. Study medication should continue until disease progression,
unacceptable toxicity, death, withdrawal of consent, or termination of the
study by the sponsor.
Participants will be followed until death or termination of the study. In
addition to survival follow-up, data will continue to be collected to evaluate
all of the secondary and other endpoints. The Euro-Quality of Life
Questionnaire will also be administered for up to 1 year after study medication
discontinuation.
Participants will be monitored for safety during the Prescreening, Screening,
and Treatment Phases and up to 30 days after the last dose of study medication
during the follow-up phase. Adverse events (AEs) including clinically
significant laboratory abnormalities reported as AEs, will be graded and
summarized using National Cancer Institute Common Terminology Criteria for
Adverse Events, Version 5.
An Independent Data Monitoring Committee will be commissioned for this study
and will perform regular review of study data.
Intervention
Participants will be randomized on a 1:1 basis to 1 of 2 treatments groups:
• niraparib 200 mg and AA 1000 mg plus prednisone 5 mg daily
• AA 1000 mg plus prednisone 5 mg daily
All study medications will be administered orally once daily. Matching placebos
will also be administered.
All participants will receive ADT (ie, gonadotropin-releasing hormone analogue
or surgical castration).
There are two groups in this study. You will randomly, or by chance, be put
into one of the groups. You will have a 50% chance of being put into 1 of 2
groups:
Group 1:
• 200mg Niraparib*
• 1000mg Abiraterone Acetate*
• 4 placebo tablets for Abiraterone Acetate
• 5mg Prednisone
*Niraparib and Abiraterone Acetate may be combined into 1 tablet (you will
receive two tablets)
Group 2:
• 2 placebo tablets
• 1000mg Abiraterone Acetate
• 5mg Prednisone
Study burden and risks
NIRAPARIB
At present, the most frequent (over 10% of the patients) possible observed side
effects are:
Decrease in red blood cells that carry oxygen; this may make you feel tired or
short of breath. Decrease in a type of blood cell called platelets that help
stop bleeding; this may increase your risk of bleeding, Decrease in a type of
white blood cell called neutrophils that fight infection; and may lead to a
potentially life-threatening condition caused by the body*s response to an
infection with or without fever, triggering changes that can damage multiple
organ systems (neutropenia, neutropenic infection, neutropenic sepsis and
febrile neutropenia), difficulty with emptying the bowels, often because of
hard stools (constipation), nausea, vomiting, decreased appetite, abdominal
pain, diarrhea, indigestion, sleeplessness, trouble sleeping, headache, feeling
tired, lack of energy / fatigue), urinary tract infection, inflammation of the
lining of the airways (bronchitis), back pain, joint pain, breathlessness or
difficulty breathing, common cold, increased blood pressure, feeling
lightheaded or like you are about to faint (dizziness), cough, noticeably
rapid, strong, or irregular heartbeat and altered sense of taste; this means
that foods might taste differently than you are used to.
ABIRATERONE ACETATE
At present, the most frequent (over 20% of the patients) possible observed side
effects are:
Hypokalaemia (low blood potassium, a mineral that helps regulate heart
rate/function, fluid balance in the body and is needed for adequate body
function) and hypertension (high blood pressure).
For prednisone and ADT
Please consult your study doctor and the package insert for information on the
risks associated with use.
You can find more information about all possible side effects and risks in
Appendix C of the informed consent.
Drawing blood may be painful You may get a bruise or irritation at the place
where the needle goes into your skin. Some patients may faint and, in rare
cases, can get an infection.
CT and bone scans involve using X-rays and radioactive markers. The amount of
radiation you will be exposed to in this study is about 20 mSv for each CT-scan
and about 2,5 mSv for each bone scan. To compare: the background radiation in
the Netherlands is ~2.5 mSv per year.
If you participate in scientific research involving exposure to radiation more
often, you should discuss with the study doctor whether participation at this
moment would be safe.
The radiation used during the study may lead to damage to your health. However,
this risk is small. We nevertheless advise you not to participate in another
scientific study involving exposure to radiation in the near future.
Examinations or procedures involving radiation for medical reasons are not a
problem.
Graaf Engelbertlaan 75
Breda 4837 DS
NL
Graaf Engelbertlaan 75
Breda 4837 DS
NL
Listed location countries
Age
Inclusion criteria
1. 18 years of age or older
2. Pathological diagnosis of prostate adenocarcinoma.
3. Willing to provide an archival tumor tissue sample or a fresh tumor tissue
sample. If germline positive for deleterious germline or somatic HRR gene
mutations, an archived or fresh tumor tissue sample is not required.
4. Metastatic disease documented by conventional imaging with computed
tomography (CT) or magnetic resonance imaging (MRI) (for soft tissue leasions)
or 99mTc bone scan (for bone leasions). Participants with a single bone lesion
on Technetium-99m (99mTc) bone scan with no other non-nodal metastatic disease
must have confirmation of bone metastatis by CT or MRI. Participants with lymph
node-only disease are not elegible.
5 Must have at least one of the deleterious germline or somatic HRR gene
mutations listed in Table 4.
6. Eastern Cooperative Oncology Group Performance Status (ECOG PS) grade <2.
7. Androgen deprivation therapy (either medical or surgical castration) must
have been started >14 days prior to randomization and participants be willing
to continue androgen deprivation therapy (ADT) through the treatment phase.
Participants who start a GnRH agonist <28 days prior to randomization will be
required to take a first-generation anti-androgen for >14 days prior to
randomization. The anti-androgen must be discontinued prior to randomization.
8. Participants who have received prior docetaxel treatment must meet the
following criteria:
a. Received a maximum of 6 cycles of docetaxel therapy for mCSPC
b. Received the last dose of docetaxel <2 months prior to randomization
c. Maintained a response to docetaxel of stable disease or better, by
investigator
assessment of imaging and PSA, prior to randomization.
9. Other allowed prior therapy for mCSPC:
a. Maximum of 1 course of radiation and 1 surgical intervention for symptomatic
control of prostate cancer (example, uncontrolled pain, impending spinal cord
compression or obstructive symptoms). Participants with radiation or surgical
interventions to all known sites of metastatic disease will be excluded from
trial participation). Radiation must be completed prior to randomization.
b. Up to a maximum of <6 months of ADT prior to randomization.
c. Up to a maximum of 45 days of abiraterone acetate + prednisone (AA-P) prior
to randomization.
d. Up to a maximum of 2 weeks of ketoconazole for prostate cancer prior to
randomization.
10. Allowed prior treatments for localized prostate cancer (all treatments must
have been
completed >=1 year prior to randomization):
a. <=3 years total of ADT
b. All other forms of prior therapies including radiation therapy,
prostatectomy, lymph node dissection, and systemic therapies.
11. Clinical laboratory values at Screening:
a. Absolute neutrophil count >=1.5 x 109/L
b. Hemoglobin >=9.0 g/dL, independent of transfusions for at least 28 days
c. Platelet count >=100 x 109/µL
d. Serum albumin >=3.0 g/dL
e. Creatinine <2 x upper limit of normal (ULN)
f. Serum potassium >=3.5 mmol/L
g. Serum total bilirubin <=1.5× ULN or direct bilirubin <=1 x ULN (Note: In
participants with Gilbert*s syndrome, if total bilirubin is >1.5 × ULN, measure
direct and indirect bilirubin, and if direct bilirubin is <=1.5 × ULN,
participant may be eligible as determined by the medical monitor)
h. AST or ALT <=3 × ULN
12. Able to swallow the study medication tablets whole.
13. Must provide informed consent (written or remote/virtual) indicating that
he understands the purpose of, and procedures required for, the study and is
willing to participate in the study including providing a DNA sample.
14. While on study medication and for 3 months following the last dose of study
medication, a male participant must wear a condom when engaging in any activity
that allows for passage of ejaculate to another person. Male participants
should also be advised of the benefit for a female partner to use a highly
effective method of contraception as condom may break or leak. The investigator
should advise of the potential for contraceptive
method failure (eg, noncompliance, recently initiated) in relationship to the
first dose of study medication. Highly effective methods of contraception
include:
a. established use of oral, injected or implanted hormonal methods of
contraception; placement of an intrauterine device or intrauterine system;
b. barrier methods: condom with spermicidal foam/gel/film/cream/suppository or
occlusive cap (diaphragm or cervical/vault caps) with spermicidal
foam/gel/film/cream/suppository.
15. A male participant must agree not to donate sperm for the purpose of
reproduction during the study and for a minimum of 3 months after receiving the
last dose of study medication.
Exclusion criteria
1. Pathological finding consistent with small cell ductal or neuroendocrine
carcinoma of the prostate.
2. Prior treatment with a PARP inhibitor.
3.Prior AR-targeted therapy (eg, ketoconazole for prostate cancer, apalutamide,
enzalutamide, darolutamide), immunotherapy, or radiopharmaceutical agents with
the exception of only 30 days of AA-P allowed prior to randomization.
4. Initiation of treatment with a bisphosphonate or denosumab for the
management of bone metastasis <28 days prior to randomization.
5. History of adrenal dysfunction
6. Long-term use of systemically administered corticosteroids >5 mg of
prednisone or the equivalent) during the study is not allowed. Short-term use
(<=4 weeks, including taper) and locally administered steroids (eg, inhaled,
topical, ophthalmic, and intra-articular) are allowed, if clinically indicated.
7. Active malignancies (ie, progressing or requiring treatment change in the
last 24 months) other than the disease being treated under study. The only
allowed exceptions are:
a. non-muscle invasive bladder cancer;
b. skin cancer (non-melanoma or melanoma) treated within the last 24 months
that is considered completely cured;
c. breast cancer - adequately treated lobular carcinoma in situ or ductal
carcinoma in situ;
d. malignancy that is considered cured with minimal risk of recurrence.
8. History or current diagnosis of MDS/AML.
9. Current evidence within 6 months prior to randomization of any of the
following: severe/unstable angina, myocardial infarction, symptomatic
congestive heart failure, clinically significant arterial or venous
thromboembolic events (eg, pulmonary embolism), or clinically significant
ventricular arrhythmias.
10. Presence of sustained uncontrolled hypertension (systolic blood pressure
>160 mm Hg or diastolic blood pressure >100 mm Hg). Participants with a history
of hypertension are allowed, provided that blood pressure is controlled to
within these limits by an antihypertensive
treatment.
11. Known allergies, hypersensitivity, or intolerance to the excipients of
niraparib, AA, or niraparib/AA FDC (refer to the IBs for niraparib and AA).
12. Current evidence of any medical condition that would make prednisone use
contraindicated.
13. Received an investigational intervention (including investigational
vaccines) or used an invasive investigational medical device within 30 days
before the planned first dose of study medication.
14. Participants who have had the following <=28 days prior to randomization:
a. A transfusion (platelets or red blood cells);
b. Hematopoietic growth factors;
c. Major surgery (sponsor should be consulted regarding what constitutes major
surgery).
15. Known active hepatitis B virus (eg, hepatitis B surface antigen reactive)
or active hepatitis C virus (HCV; eg, HCV ribonucleic acid [RNA] [qualitative]
is detected).
16. Human immunodeficiency virus positive participants with 1 or more of the
following:
a. Not receiving highly active antiretroviral therapy or on antiretroviral
therapy for less than 4 weeks.
b. Receiving antiretroviral therapy that may interfere with the study
medication (consult the sponsor for review of medication prior to enrollment).
c. A change in antiretroviral therapy within 6 months of the start of screening
(except if, after consultation with the sponsor on exclusion criterion 16.b, a
change is made to avoid a potential drug-drug interaction with the study
medication).
d. CD4 count<350 at screening.
e. An acquired immunodeficiency syndrome-defining opportunistic infection
within 6 months of the start of screening.
f. Human immunodeficiency virus load >400 copies/mL.
Design
Recruitment
Medical products/devices used
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
EU-CTR | CTIS2023-506365-64-00 |
EudraCT | EUCTR2020-002209-25-NL |
ClinicalTrials.gov | NCT04497844 |
CCMO | NL69021.056.20 |