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Flutamide With or Without Vaccine Therapy in Treating Patients With Nonmetastatic Prostate Cancer
This study is currently recruiting participants.
Verified by National Cancer Institute (NCI), November 2008
Sponsored by: National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00450463
  Purpose

RATIONALE: Androgens can cause the growth of prostate cancer cells. Antihormone therapy, such as flutamide, may lessen the amount of androgens made by the body. Vaccines made from a gene-modified virus may help the body build an effective immune response to kill tumor cells. Giving flutamide together with vaccine therapy may kill more tumor cells.

PURPOSE: This randomized phase II trial is studying flutamide and vaccine therapy to see how well they work compared with flutamide alone in treating patients with nonmetastatic prostate cancer.


Condition Intervention Phase
Prostate Cancer
Drug: flutamide
Drug: recombinant fowlpox-prostate apecific antigen vaccine
Drug: recombinant vaccinia prostate-specific antigen vaccine
Drug: sargramostim
Phase II

MedlinePlus related topics: Cancer Prostate Cancer
Drug Information available for: Sargramostim Granulocyte-macrophage colony-stimulating factor Metronidazole Metronidazole hydrochloride Metronidazole phosphate Flutamide PANVAC-V
U.S. FDA Resources
Study Type: Interventional
Study Design: Treatment, Randomized
Official Title: A Randomized Phase II Trial Combining Vaccine Therapy With Prostvac/Tricom and Flutamide, Vs Flutamide Alone in Men With Androgen Insensitive, Non Metastatic (D0.5) Prostate Cancer

Further study details as provided by National Cancer Institute (NCI):

Primary Outcome Measures:
  • Time to treatment failure [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Time to development of metastatic disease [ Designated as safety issue: No ]
  • Toxicity [ Designated as safety issue: Yes ]

Estimated Enrollment: 70
Study Start Date: February 2007
Estimated Primary Completion Date: November 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Arm I: Active Comparator
Patients receive flutamide orally 3 times a day on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After 3 months of treatment, patients who do not develop clinical progression, but develop biochemical recurrence (e.g., rising PSA levels) without metastatic disease (as evidenced on scans), may receive vaccine treatment as defined in arm II beginning 4 weeks after flutamide therapy is discontinued.
Drug: flutamide
Given orally
Arm II: Experimental
Patients receive flutamide orally 3 times a day on days 1-28. Patients also receive recombinant vaccinia PSA vaccine subcutaneously (SC) on day 1 of course 1 only and recombinant fowlpox PSA vaccine SC on day 1 of all subsequent courses. Patients receive sargramostim (GM-CSF) SC on days 1-4. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. After 3 months of treatment, patients who do not develop clinical progression, but develop biochemical recurrence (e.g., rising PSA levels), discontinue flutamide but may continue to receive vaccine treatment.
Drug: flutamide
Given orally
Drug: recombinant fowlpox-prostate apecific antigen vaccine
Given subcutaneously
Drug: recombinant vaccinia prostate-specific antigen vaccine
Given subcutaneously
Drug: sargramostim
Given subcutaneously

Detailed Description:

OBJECTIVES:

Primary

  • Determine if flutamide with vs without vaccine therapy comprising recombinant vaccinia prostate-specific antigen (PSA) vaccine and recombinant fowlpox PSA vaccine is associated with a trend toward improvement in time to treatment failure (defined as a rising PSA, development of metastatic disease, or removal from treatment due to excessive toxicity) in patients with androgen insensitive, nonmetastatic prostate cancer.

Secondary

  • Determine, preliminarily, any patterns of immunologic effects that differ by treatment, including the immunologic effects of flutamide withdrawal in patients continuing on vaccine therapy after a rising PSA on flutamide.
  • Compare the toxicity of these regimens in these patients.
  • Evaluate, preliminarily, the effect of vaccine therapy on the development of metastatic disease after PSA progression in these patients.
  • Evaluate PSA responses and immune responses in patients who discontinue flutamide at the time of PSA progression and either continue vaccine therapy or have vaccine therapy initiated at the time of flutamide discontinuation.
  • Assess response rate in patients randomized to both arms as well as responses in those patients who crossover from the flutamide only arm.

OUTLINE: This is a randomized, pilot, crossover study. Patients are stratified according to prostate-specific antigen (PSA) doubling time (> 10 months vs ≤ 10 months) using the last two PSA values 1 month apart prior to enrollment on study. Patients are randomized to 1 of 2 treatment arms.

  • Arm I: Patients receive flutamide orally 3 times a day on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

After 3 months of treatment, patients who do not develop clinical progression, but develop biochemical recurrence (e.g., rising PSA levels) without metastatic disease (as evidenced on scans), may receive vaccine treatment as defined in arm II beginning 4 weeks after flutamide therapy is discontinued.

  • Arm II: Patients receive flutamide orally 3 times a day on days 1-28. Patients also receive recombinant vaccinia PSA vaccine subcutaneously (SC) on day 1 of course 1 only and recombinant fowlpox PSA vaccine SC on day 1 of all subsequent courses. Patients receive sargramostim (GM-CSF) SC on days 1-4. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

After 3 months of treatment, patients who do not develop clinical progression, but develop biochemical recurrence (e.g., rising PSA levels), discontinue flutamide but may continue to receive vaccine treatment.

All patients undergo blood collection periodically for immunological studies. Blood serum is analyzed for interferon gamma-releasing T-cells specific to PSA-3A, as measured by ELISPOT assay, as well as antibodies to PSA, vaccinia, fowlpox, and antinuclear antibody titer by immunoenzyme techniques.

After completion of study treatment, patients are followed periodically for up to 5 years.

PROJECTED ACCRUAL: A total of 70 patients will be accrued for this study.

  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically confirmed prostate cancer

    • Nonmetastatic disease

      • No evidence of metastatic disease on CT scan or bone scan
  • Androgen-insensitive disease meeting the following criteria:

    • Rising prostate-specific antigen (PSA)* on prior antiandrogen therapy (i.e., bicalutamide or nilutamide)
    • Evidence of a rising PSA* after withdrawal of nilutamide or bicalutamide NOTE: *A rising PSA is defined as 2 consecutively rising PSA levels, separated by ≥ 1 month apart, with the last measurement > 1 ng/mL
  • Concurrent gonadotropin releasing-hormone agonist or antagonist required for patients who have not undergone bilateral surgical orchiectomy or for patients who have PSA progression and are taken off flutamide
  • No known brain metastasis

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-1
  • Life expectancy ≥ 6 months
  • Platelet count ≥ 100,000/mm^3
  • Hemoglobin ≥ 9 g/dL
  • Granulocyte count ≥ 1,500/mm^3
  • Lymphocyte count ≥ 500/mm^3
  • Bilirubin ≤ 1.5 mg/dL (≤ 3.0 mg/dL for patients with Gilbert's syndrome)
  • AST and ALT < 2.5 times upper limit of normal
  • Proteinuria < grade 2 (unless the cause is determined not to be renal)
  • Creatinine clearance ≥ 60 mL/min
  • No other active malignancy within the past 5 years except for nonmelanoma skin cancer or carcinoma in situ of the bladder
  • No other life-threatening illness
  • No history of seizures, encephalitis, or multiple sclerosis
  • Fertile patients must use effective contraception during and for 4 months after completion of study therapy
  • No active hepatitis B or hepatitis C infection
  • No evidence of being immunocompromised, including any of the following:

    • HIV positivity
    • Patients who have undergone allogeneic peripheral blood stem cell transplantation or solid organ transplantation requiring immunosuppression
  • No autoimmune diseases that required treatment, including any of the following:

    • Addison's disease
    • Hashimoto's thyroiditis
    • Systemic lupus erythematosus
    • Sjögren's syndrome
    • Scleroderma
    • Myasthenia gravis
    • Goodpasture syndrome
    • Active Graves' disease
  • No history of allergy or untoward reaction to prior vaccination with vaccinia virus or to any component of the vaccinia vaccine regimen
  • No concurrent serious medical illness (e.g., one that requires treatment) that would preclude study treatment including, but not limited to, any of the following:

    • Inflammatory bowel disease
    • Crohn's disease
    • Ulcerative colitis
    • Active diverticulitis
  • No cardiac disease, angina, or New York Heart Association class II-IV heart disease
  • No history of congestive heart failure or objective evidence of congestive heart failure by physical exam or imaging
  • No pulmonary disease accompanied by fatigue or dyspnea with ordinary physical activity
  • No serious hypersensitivity reaction to egg products
  • Must be able to avoid close contact (e.g., share the same house or has close physical contact) with any of the following individuals for ≥ 3 weeks after treatment with the study vaccine:

    • Individuals with a history of or active eczema or other eczematoid skin disorders
    • Individuals with other active, chronic, or exfoliative skin conditions, including any of the following:

      • Atopic dermatitis
      • Burns
      • Impetigo
      • Varicella zoster
      • Severe acne
      • Other open rashes or wounds
    • Pregnant or nursing women
    • Children ≤ 3 years of age
    • Immunodeficient or immunosuppressed individuals either by disease or therapy, including HIV infection

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior therapy or surgery
  • At least 6 weeks since prior bicalutamide
  • At least 4 weeks since prior nilutamide
  • No prior flutamide for > 1 month in duration
  • No prior splenectomy
  • More than 2 weeks since prior steroid eye drops
  • No prior or concurrent systemic steroids

    • Local (e.g., topical, nasal, or inhaled) steroids allowed
  • No concurrent therapy, including any of the following:

    • Chemotherapy or other anticancer treatment
    • Alternative medicines
    • Radiotherapy
    • Major surgical procedures
    • Nonprotocol-related immunotherapy
    • Other hormonal therapy
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00450463

Locations
United States, Maryland
Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office Recruiting
Bethesda, Maryland, United States, 20892-1182
Contact: Clinical Trials Office - Warren Grant Magnusen Clinical Center     888-NCI-1937        
Sponsors and Collaborators
Investigators
Principal Investigator: James Gulley, MD, PhD National Cancer Institute (NCI)
Study Chair: Ravi Madan, MD NCI - Medical Oncology Branch
  More Information

Clinical trial summary from the National Cancer Institute's PDQ® database  This link exits the ClinicalTrials.gov site
Web site for additional information  This link exits the ClinicalTrials.gov site

Study ID Numbers: CDR0000535593, NCI-07-C-0107
Study First Received: March 20, 2007
Last Updated: December 11, 2008
ClinicalTrials.gov Identifier: NCT00450463  
Health Authority: Unspecified

Keywords provided by National Cancer Institute (NCI):
stage I prostate cancer
stage II prostate cancer
stage III prostate cancer
recurrent prostate cancer
stage IV prostate cancer

Study placed in the following topic categories:
Metronidazole
Prostatic Diseases
Genital Neoplasms, Male
Urogenital Neoplasms
Flutamide
Genital Diseases, Male
Prostatic Neoplasms
Recurrence

Additional relevant MeSH terms:
Androgen Antagonists
Neoplasms
Neoplasms by Site
Antineoplastic Agents, Hormonal
Antineoplastic Agents
Hormone Antagonists
Therapeutic Uses
Physiological Effects of Drugs
Hormones, Hormone Substitutes, and Hormone Antagonists
Pharmacologic Actions

ClinicalTrials.gov processed this record on January 14, 2009