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Calcitriol, Ketoconazole, and Hydrocortisone in Treating Patients With Advanced or Recurrent Prostate Cancer
This study is ongoing, but not recruiting participants.
First Received: September 27, 2007   Last Updated: April 18, 2009   History of Changes
Sponsors and Collaborators: Roswell Park Cancer Institute
National Cancer Institute (NCI)
Information provided by: National Cancer Institute (NCI)
ClinicalTrials.gov Identifier: NCT00536991
  Purpose

RATIONALE: Calcitriol may help prostate cancer cells become more like normal cells and grow and spread more slowly. Ketoconazole may help calcitriol work better by making tumor cells more sensitive to the drug. Giving calcitriol together with ketoconazole and hydrocortisone may be an effective treatment for prostate cancer.

PURPOSE: This phase I/II trial is studying the side effects and best dose of calcitriol when given together with ketoconazole and hydrocortisone and to see how well it works in treating patients with advanced or recurrent prostate cancer.


Condition Intervention Phase
Prostate Cancer
Dietary Supplement: calcitriol
Drug: ketoconazole
Drug: therapeutic hydrocortisone
Phase I
Phase II

Study Type: Interventional
Study Design: Treatment
Official Title: A Phase I/II Study of Oral Calcitriol in Combination With Ketoconazole in Androgen Independent Prostate Cancer

Resource links provided by NLM:


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

Primary Outcome Measures:
  • Maximum tolerated dose of calcitriol (phase I) [ Designated as safety issue: Yes ]
  • Prostate-specific antigen response rate (complete and partial) (phase II) [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Toxicity as measured by NCI CTC version 3.0 [ Designated as safety issue: Yes ]
  • Objective tumor response as measured by monthly physical exam and radiographic evaluation every 12 weeks [ Designated as safety issue: No ]

Estimated Enrollment: 60
Study Start Date: October 2006
Estimated Primary Completion Date: July 2010 (Final data collection date for primary outcome measure)
Detailed Description:

OBJECTIVES:

Primary

  • To determine the maximum tolerated dose (MTD) of oral calcitriol when given together with ketoconazole and hydrocortisone in patients with advanced or recurrent androgen-independent prostate cancer. (Phase I)
  • To estimate the prostate-specific antigen response rate. (Phase II)

Secondary

  • To evaluate the pharmacokinetics of the phase II dose of calcitriol with and without ketoconazole.
  • Describe any objective tumor responses to the combination of calcitriol, ketoconazole, and hydrocortisone among patients with measurable disease using RECIST criteria.
  • Explore the pharmacodynamic effects of this combination in peripheral blood mononuclear cells.
  • Determine toxicities and tolerability of this regimen.

OUTLINE: This is a phase I, dose-escalation study of calcitriol followed by a phase II study.

  • Phase I: Patients receive oral calcitriol once daily on days 1-3, 8-10, 15-17, and 22-24, oral ketoconazole three times daily on days 1-28, and oral hydrocortisone twice daily on days 0-28 of course 1 and days 1-28 of all subsequent courses. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of calcitriol until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
  • Phase II: Patients receive oral calcitriol at the MTD determined in phase I on days 1-3, 8-10, 15-17, and 22-24, oral ketoconazole three times daily on days 4-28, and oral hydrocortisone as in phase I. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Peripheral blood mononuclear cells are collected periodically to evaluate the pharmacodynamics of calcitriol, hydrocortisone, and ketoconazole. Some patients undergo blood collection on days 1 and 15 for calcitriol pharmacokinetic studies.
  Eligibility

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

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed androgen-independent adenocarcinoma of the prostate

    • Advanced or recurrent disease for which standard curative or reliable palliative therapy does not exist or is no longer effective
  • Measurable disease with elevated prostate-specific antigen (PSA) or evaluable disease (PSA elevation will constitute evaluable disease)
  • Patients who have received prior antiandrogens or progestational agents as therapy for prostate cancer must discontinue therapy and demonstrate a rising PSA ≥ 28 days* after discontinuation NOTE: *At least 42 days for bicalutamide or nilutamide
  • Patients undergoing androgen deprivation using luteinizing hormone-releasing hormone (LHRH) analogues must continue therapy or undergo orchiectomy to maintain castrate levels of testosterone
  • Patients with brain metastases which are stable and have been treated for surgery or irradiation are eligible

PATIENT CHARACTERISTICS:

  • ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100%
  • Life expectancy > 3 months
  • Leukocytes ≥ 3,000/mm^3
  • Hemoglobin ≥ 8 g/dL
  • Absolute neutrophil count ≥ 1,500/mm^3
  • Platelet count ≥ 75,000/mm^3
  • Total bilirubin normal
  • AST/ALT ≤ 2.5 x upper limit of normal
  • Creatinine ≤ 2 mg/dL
  • Calcium normal
  • Must be able to receive oral medications, including oral capsules
  • No known severe hypersensitivity to ketoconazole, calcitriol, or any of the excipients of these products
  • No history of allergic reaction attributed to compounds of similar chemical or biologic composition to calcitriol, ketoconazole, or other agents used in the study
  • No evidence of any other significant clinical disorder or laboratory finding that would make it undesirable for the patient to participate in the trial
  • No history of kidney, ureteral, or bladder stones within the past 5 years
  • No incomplete healing from prior oncologic treatments or other major surgery
  • No unresolved chronic toxicity > grade 2
  • No heart failure or significant heart disease, including any of the following:

    • Significant arrhythmias
    • Myocardial infarction within the past 3 months
    • Unstable angina pectoris
    • Documented ejection fraction < 30%
  • No other severe or uncontrolled systemic disease (e.g., unstable or compensated respiratory, cardiac, hepatic, or renal disease) or intercurrent illness including, but not limited to any of the following:

    • Ongoing or active infection
    • Symptomatic congestive heart failure
    • Psychiatric illness/social situation that would limit compliance with study requirements

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • Recovered from prior anticancer therapy
  • At least 7 days since prior thiazide therapy
  • At least 30 days since prior treatment with a non-approved or investigational drug or agent
  • At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C)
  • At least 4 weeks since prior radiotherapy or cytotoxic therapy
  • No more than 2 prior cytotoxic chemotherapy regimens

    • Retinoids, vitamin D analogues, PPARγ agonists or antagonists, antiandrogens, progestational agents, estrogens, PC-SPES, LHRH analogues, vaccines, and cytokines are not considered cytotoxics
    • Prior ketoconazole and glycocorticoids allowed
  • Concurrent megestrol acetate for hot flashes at a dose of ≤ 40 mg/day allowed
  • No concurrent digoxin therapy
  • No concurrent systemic glucocorticoid therapy at greater than physiologic replacement doses
  • No concurrent calcium supplementation
  • No concurrent combination antiretroviral therapy for HIV-positive patients
  • No concurrent proton pump inhibitors or H2 blockers
  • No concurrent use of any of the following:

    • Phenytoin
    • Carbamazepine
    • Barbiturates
    • Rifampicin
    • Phenobarbital
    • Hypericum perforatum (St. John wort)
    • Alfentanil
    • Alfuzosin
    • Almotriptan
    • Alprazolam
    • Amiodarone
    • Amitriptyline
    • Aprepitant
    • Amprenavir
    • Aripiprazole
    • Bepridil
    • Bortezomib
    • Bosentan
    • Budesonide
    • Buprenorphine
    • Buspirone
    • Cilostazol
    • Cisapride
    • Cyclosporine
    • Delavirdine
    • Didanosine
    • Digoxin
    • Disopyramide dofetilide
    • Donepezil
    • Eletriptan
    • Eplerenone
    • Fluticasone
    • Fosamprenavir
    • Galantamine
    • Systemic griseofulvin
    • Indinavir
    • Levobupivacaine
    • Lopinavir
    • Midazolam
    • Mifepristone
    • Modafinil
    • Nateglinide
    • Nefazodone
    • Nelfinavir
    • Oxcarbazepine
    • Pimozide
    • Quetiapine
    • Quinidine
    • Repaglinide
    • Rifabutin
    • Rifampin
    • Rifapentine
    • Ritonavir
    • Saquinavir
    • Valdecoxib
    • Vardenafil
    • Ziprasidone
    • Statins
    • Calcium channel blockers
    • Coumadin
    • Macrolides
    • Sildenafil
    • Sirolimus
    • Tacrolimus
    • Tadalafil
    • Tolterodine
    • Theophyllines
    • Triazolam
    • Zonisamide
    • Other agents that would be significantly perturbed in a clinically important way by the P450 inhibitory properties of ketoconazole
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00536991

Locations
United States, New York
Roswell Park Cancer Institute
Buffalo, New York, United States, 14263-0001
Sponsors and Collaborators
Roswell Park Cancer Institute
Investigators
Principal Investigator: Donald L. Trump, MD Roswell Park Cancer Institute
  More Information

Additional Information:
No publications provided

Responsible Party: Roswell Park Cancer Institute ( Donald L. Trump )
Study ID Numbers: CDR0000565063, RPCI-I-68905
Study First Received: September 27, 2007
Last Updated: April 18, 2009
ClinicalTrials.gov Identifier: NCT00536991     History of Changes
Health Authority: United States: Federal Government

Keywords provided by National Cancer Institute (NCI):
adenocarcinoma of the prostate
recurrent prostate cancer
stage III prostate cancer
stage IV prostate cancer

Study placed in the following topic categories:
Anti-Inflammatory Agents
Anti-Infective Agents
Hydrocortisone
Genital Neoplasms, Male
Prostatic Diseases
Cortisol succinate
Bone Density Conservation Agents
Trace Elements
Urogenital Neoplasms
Cardiovascular Agents
Genital Diseases, Male
Ketoconazole
Recurrence
Calcitriol
Calcium, Dietary
Antifungal Agents
Vitamins
Vasoconstrictor Agents
Micronutrients
Hydrocortisone acetate
Adenocarcinoma
Prostatic Neoplasms
Androgens

Additional relevant MeSH terms:
Anti-Inflammatory Agents
Anti-Infective Agents
Hydrocortisone
Prostatic Diseases
Genital Neoplasms, Male
Molecular Mechanisms of Pharmacological Action
Physiological Effects of Drugs
Calcium Channel Agonists
Urogenital Neoplasms
Bone Density Conservation Agents
Calcitriol
Membrane Transport Modulators
Neoplasms by Site
Antifungal Agents
Vitamins
Therapeutic Uses
Vasoconstrictor Agents
Micronutrients
Cortisol succinate
Growth Substances
Cardiovascular Agents
Ketoconazole
Genital Diseases, Male
Pharmacologic Actions
Neoplasms
Hydrocortisone acetate
Prostatic Neoplasms

ClinicalTrials.gov processed this record on September 11, 2009