Phase I/II dose-escalation trial of fractionated dose 177Lu-J591 plus 177Lu-PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC).

Authors

Scott Tagawa

Scott T. Tagawa

Division of Hematology & Medical Oncology, Meyer Cancer Center, Department of Urology, Weill Cornell Medical College & New York-Presbyterian Hospital, New York, NY

Scott T. Tagawa , Muhammad Junaid Niaz , Joseph Osborne , Shankar Vallabhajosula , Himisha Beltran , Lauren Christine Harshman , David M. Nanus , Ana M. Molina , Bishoy Morris Faltas , Amy Hackett , Lauren Gracey , Jyothi Sreekumar , John Babich , Karla V. Ballman , Neil Harrison Bander

Organizations

Division of Hematology & Medical Oncology, Meyer Cancer Center, Department of Urology, Weill Cornell Medical College & New York-Presbyterian Hospital, New York, NY, Weill Cornell Medical College, New York, NY, Stanford University School of Medicine, Stanford, CA, Sandra and Edward Meyer Cancer Center, New York, NY, Weill Cornell Medicine, New York, NY

Research Funding

Other

Background: PC is a radiosensitive disease. PSMA is selectively overexpressed in advanced PC with upregulation by androgen receptor (AR) pathway dysregulation; limited expression exists in other organs. Prior studies of beta-emitting radiolabeled anti-PSMA antibody J591 demonstrated accurate targeting, efficacy with dose-response effect, and safety with predictable dose-limiting myelosuppression. Recent prospective trials have shown efficacy and safety of 177Lu-PSMA-617 in mCRPC. Studies demonstrate different binding sites of J591 and PSMA-617 and co-administration leads to non-competitive additive binding and delivery of payloads to PSMA+ cells. As the pharmacokinetics and biodistribution of the 2 agents is mostly non-overlapping (other than tumor) and given our prior dose-response data, we hypothesize that delivery of the combination will yield higher tumor delivery with less off-target toxicity (i.e. better responses without increased toxicity). Methods: Men with progressive mCRPC following at least 1 potent AR-targeted agent (e.g. abi/enza) and docetaxel (or unfit/refuse chemo) with metastatic disease on CT/MRI or bone scan without limit of # prior therapies (excluding bone-targeted beta-emitting radioisotopes) provided adequate organ function will be enrolled. Pre-treatment 88Ga-PSMA-11 will be performed, but results are not used for eligibility. Treatment includes fractionated 177Lu-J591 at a fixed moderate dose with escalating doses of 177Lu-PSMA-617 (7.4 – 18.5 GBq per cycle, fractionated D1 and D15) in a 3+3 dose-escalation study. Dose-limiting toxicity (DLT) is defined as attributable grade > 3 heme toxicity or grade > 2 non-heme toxicity. Following determination of recommended phase 2 dose (RP2D), the phase 2 portion will enroll in a 2-stage design. Primary endpoints: DLT and RP2D (ph 1) and PSA decline proportion (ph 2). Secondary endpoints include toxicity, radiographic response, PFS, rPFS, OS, CTC count changes. Correlatives include baseline/follow up PSMA imaging, whole body distribution of 177Lu, tissue and circulating genomic assessment, immunologic assessment, and patient reported outcomes (FACT-P and BPI-SF). Clinical trial information: NCT03545165

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Abstract Details

Meeting

2019 Genitourinary Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session A: Prostate Cancer

Track

Prostate Cancer,Prostate Cancer

Sub Track

Prostate Cancer - Advanced Disease

Clinical Trial Registration Number

NCT03545165

Citation

J Clin Oncol 37, 2019 (suppl 7S; abstr TPS339)

DOI

10.1200/JCO.2019.37.7_suppl.TPS339

Abstract #

TPS339

Poster Bd #

N15

Abstract Disclosures

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