Prostate Cancer Clinical Trial
M9241 in Combination With Docetaxel in Adults With Metastatic Castration Sensitive and Castration Resistant Prostate Cancer
Metastatic castration sensitive and castration resistant prostate cancer (mCSPC and mCRPC) are prostate cancers that have spread to other parts of the body. Use of the drug docetaxel with androgen deprivation therapy can improve survival for men with mCSPC. Researchers want to see if combining this treatment with other drugs can help delay the time it takes for mCSPC and mCRPC to get worse.
To learn if giving docetaxel with M9241 is safe and effective for men with prostate cancer.
Men age 18 and older with mCSPC or mCRPC.
Participants will be screened with a medical history and physical exam. Their diagnosis will be confirmed. Their symptoms and how well they do their normal activities will be reviewed. They will have blood and urine tests. Their heart will be evaluated. They will have imaging scans of the chest, abdomen, and pelvis. They will have bone scans with intravenous (IV) injections of Tc99 to check for tumor spread in the bones.
Some screening tests will be repeated during the study.
Participants may have tumor biopsies.
Participants will get treatment in cycles. Each cycle will last 21 days. They will get docetaxel through IV infusion. They will get M9241 as an injection under the skin.
Participants with mCSPC will have up to 6 cycles. Those with mCRPC will be treated until they cannot tolerate the side effects or their disease gets worse.
Participants will have a follow-up visit 30 days after treatment ends. Those with mCSPC will then have follow-up visits at the clinic every 3 months.
A phase III trial demonstrated that combining docetaxel and androgen deprivation therapy (ADT) significantly improved survival (57.6 vs 44.0 months (hazard ratio HR=0.56, (0.44- 0.70), p <0.0001) for men with metastatic castration sensitive prostate cancer (mCSPC). The greatest benefit was seen in men with high volume disease (visceral disease or 4+ bone lesions with at least one beyond the pelvis and spine.)
Clinical data has indicated that PSA <=0.20 ng/ml seven months after starting androgen deprivation therapy (ADT) is prognostic for overall survival based on data from the phase III trial.
Docetaxel has limited efficacy in metastatic castration resistant prostate cancer (mCRPC) patients who have already progressed on anti-androgen therapy (abiraterone or enzalutamide).
Preclinical data demonstrates that docetaxel increases uptake of M9241, an IL-12 immunocytokine that targets necrosis.
Additional preclinical data demonstrates the potential anti-tumor synergy of M9241 when combined with docetaxel
To evaluate safety and tolerability of docetaxel in combination with M9241 in participants who have metastatic prostate cancer.
-Determine clinical efficacy in adults with prostate cancer treated with docetaxel in combination with the immunocytokine, M9241.
For mCSPC participants: Clinical efficacy will be measured by prostate specific antigen (PSA <0.2 ng/ml) seven months after start of androgen deprivation therapy (ADT).
For mCRPC participants: Clinical efficacy will be measured by an increase in their median progression free survival (PFS).
Men age >=18 years
Histopathological confirmation of prostate cancer. If no pathologic specimen is available, participants may enroll with a pathologist s report showing a histologic diagnosis of prostate cancer and a clinical course consistent with the disease.
Participants must have metastatic disease
mCSPC participants must be within 134 days of starting ADT.
mCRPC participants must have been previously treated with ADT.
Open-label, single-center, non-randomized Phase I/II study
To ensure safety of the combination before using in larger numbers of mCSPC and mCRPC participants, M9241 will be escalated from a starting dose of 12 mcg/kg and a second dose level of 16.8 mcg/kg along with docetaxel. mCSPC participants will receive a maximum of 6 cycles. mCRPC participants will continue until progression or unacceptable toxicity.
Once the recommended phase II dose (RP2D) of M9241 has been defined, we planned to do a safety run-in cohort to include another 6 participants to determine the safety of the combination of docetaxel 75 mg/m^2 (given every 3 weeks x 6 cycles starting at Cycle 1), with M9241 at the RP2D and M7824 (2400 mg), given every 3 weeks from cycle 2 through cycle 6). Effective amendment v10/04/2021, the safety run-in cohort is closed as M7824 (bintrafusp alfa) is no longer planned to be given as part of the treatment combination.
The remaining participants will be enrolled onto the trial in the following expansion cohorts, each of which will receive the determined safe dose of M9241.
mCSPC participants: ADT followed by simultaneous docetaxel 75 mg/m^2 (given every 3 weeks x 6 cycles starting at Cycle 1), with M9241 at the RP2D, given every 3 weeks from cycle 2 through cycle 6). Prednisone is optional and may be given orally at 5 mg once a day. Androgen Deprivation Therapy (ADT) may include GnRH agonist or monthly degarelix converted to GnRH agonist after 3 months
mCRPC participants: docetaxel 75 mg/m^2 (given every 3 weeks starting at Cycle 1) with M9241 at the RP2D, given every 3 weeks from cycle 2 onwards until disease progression or unacceptable toxicity. Prednisone will be given 5 mg twice a day for each dose or 10 mg once a day. ADT will be continued as per standard of care. Testosterone suppression will be maintained throughout the study
It is anticipated that approximately 4 years may be required for accrual of up to 80 participants.
Participants must have documented histopathological confirmation of prostate cancer. If no pathologic specimen is available, participants may enroll with a pathologist's report showing a histologic diagnosis of prostate cancer and a clinical course consistent with the disease.
Participants must have metastatic disease, defined as at least one lesion on TC99 bone scan or at least one lesion that is measurable per, per RECIST 1.1.
Participants must be within 134 days of starting ADT.
If participants are on ADT and responding, this may impact the findings on scans. Pre- treatment scans could be used to confirm that participants have metastatic high-volume disease in such cases.
For Cohorts 1 and 2, Dose escalation and Safety Run-in, only: mCSPC may have high or low volume disease.
For Cohort 3, Dose Expansion: mCSPC participants must have high volume disease (as defined by visceral lesion or 4 or greater bone lesions, at least one of which is beyond the spine and pelvis).
Must have been previously treated with modern anti-androgens such as abiraterone, enzalutamide, apalutamide, or darolutamide.
Must have not had progression while on docetaxel if given for mCSPC or within 3 months of completing docetaxel for mCSPC.
Progression defined as either rising PSA greater than 2.0 ng/ml or radiographic evidence of progression seen on CT scan or TC-99 bone scan.
Toxicities related to prior therapy, including surgery and/ or radiation, must have resolved to <= grade 1.
Men age >=18 years. Because no dosing or adverse event data are currently available on the use of M9241 in combination with docetaxel in participants <18 years of age, children are excluded from this study.
ECOG performance status 0-2.
Participants must have adequate organ and marrow function as defined below:
Absolute neutrophil count >=1,500/mcL, without CSF support
Hemoglobin >9 g/dL
PT <= 1.5 x ULN
aPIT <= 1.5 x ULN
Total bilirubin <= upper limit of normal (ULN), OR in participants with Gilbert s syndrome, a total bilirubin <= 3.0
Serum albumin >=2.8 g/dL
AST(SGOT)/ALT(SGPT) <=1.5 X institutional upper limit of normal
Serum Creatinine OR Creatinine Clearance <= 1.5 X institutional upper limits of normal OR >=50 mL/min/1.73 m^2 calculated by eGFR in the clinical lab for participants with serum creatinine levels > 1.5 ULN
The effects of M9241 in combination with docetaxel on the developing human fetus are unknown. For this reason and because docetaxel agents as well as other immuno-therapeutic agents used in this trial are known to be teratogenic, sexually active subjects and their female partners must agree to use medically accepted barrier methods of contraception (e.g., male or female condom)after enrollment on study , during the study treatment and for 3 months after the last dose of docetaxel or M921, even if oral contraceptives are also used. Should a woman become pregnant or suspect she is pregnant while her partner is participating in this study, she should inform her treating physician immediately and her partner should inform the study doctor immediately.
Ability of subject to understand and the willingness to sign a written informed consent document. Subject should be willing to travel to the NIH for follow-up visits.
Participants with prior immune checkpoint therapy are eligible to enroll upon PI discretion.
Immunocompromised status due to:
Human immunodeficiency virus (HIV) positivity
Active autoimmune diseases such as Addison's disease, Hashimoto's thyroiditis, systemic lupus erythematosus, Sjogren syndrome, scleroderma, myasthenia gravis, Goodpasture syndrome or active Grave's disease. Participants with a history of autoimmunity that has not required systemic immunosuppressive therapy or does not threaten vital organ function including CNS, heart, lungs, kidneys, skin, and GI tract will be allowed.
Other immunodeficiency diseases that in the opinion of the investigator could compromise the participants or limit treatment efficacy
Serious intercurrent medical illness that, in the judgment of the investigator, would interfere with participant s ability to carry out the treatment program.
Current use of other medications for urinary symptoms including 5-alpha reductase inhibitors (finasteride and dutasteride) and alternative medications known to alter PSA (e.g. phytoestrogens and saw palmetto).
Receipt of any investigational agent within 28 days (or 60 days for an antibody-based therapy) before the first planned dose of study drugs.
Participants who are positive for Hepatitis B surface antigen and/or Anti-Hepatitis C antibody
Uncontrolled hypertension (SBP>170/ DBP>105)
Has received or will receive a live vaccine within 30 days prior to the first administration of study intervention. Seasonal flu vaccines that do not contain a live virus are permitted. Locally approved COVID vaccines are permitted.
Participants who have had prior docetaxel for mCRPC
Participants who have had progression within 3 months of completing docetaxel for mCSPC
History of allergic reactions attributed to compounds of similar chemical or biologic composition to M9241 investigational agents used in the study
The subject has had evidence within 2 years of the start of study treatment of another active malignancy which required systemic treatment (except for nonmelanoma skin cancers or carcinoma in situ of the bladder).
The subject has active brain metastases or epidural disease.
Participants with greater than or equal to grade 2 peripheral neuropathy (defined by CTCAE 5.0) at baseline.
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