ENZA-p: A randomized phase II trial using PSMA as a therapeutic agent and prognostic indicator in men with metastatic castration-resistant prostate cancer treated with enzalutamide (ANZUP 1901).

Authors

null

Louise Emmett

Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, Australia

Louise Emmett , Shalini Subramaniam , Andrew James Martin , Alison Yan Zhang , Sonia Yip , Megan Crumbaker , Nisha Rana , Roslyn J. Francis , Michael S Hofman , Anthony M. Joshua , Shahneen Kaur Sandhu , Arun Azad , Craig Gedye , Andrew James Weickhardt , Jeffrey C. Goh , Siobhan Ng , Mark Voskoboynik , Margaret Mary McJannett , Martin R. Stockler , Ian D. Davis

Organizations

Department of Theranostics and Nuclear Medicine, St Vincent's Hospital, Sydney, Australia, NHMRC Clinical Trials Center, The University of Sydney, Sydney, Australia, NHMRC Clinical Trials Center, University of Sydney, Sydney, Australia, NHMRC Clinical Trials Center, University of Sydney, Sydney, NSW, Australia, NHMRC Clinical Trials Center, University of Sydney, Camperdown, NSW, Australia, The Kinghorn Cancer Centre, St. Vincent's Hospital, Sydney, Australia, Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, NSW, Australia, Sir Charles Gairdner Hospital, Perth, WA, Australia, Peter MacCallum Cancer Center and University of Melbourne, Melbourne, VIC, Australia, Kinghorn Cancer Center, St Vincent's Hospital, Darlinghurst, NSW, Australia, Peter MacCallum Cancer Center, Melbourne, VIC, Australia, Peter MacCallum Cancer Center, Sydney, Australia, Calvary Mater Newcastle, Waratah, NSW, Australia, Austin Health, Heidelberg, Australia, Royal Brisbane and Women's Hospital, Herston and University of Queensland, St. Lucia, QLD, Australia, Sir Charles Gairdner Hospital, Perth, Australia, Alfred Hospital, Melbourne, Australia, Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia

Research Funding

Other

Background: 177Lu‐PSMA‐617 (LuPSMA) is a novel radionuclide with promising activity and tolerability in metastatic castration-resistant prostate cancer (mCRPC). Pre-clinical studies have shown that androgen receptor blockade with enzalutamide upregulates PSMA-receptor expression, and that PSMA-receptor blockade increases treatment response to enzalutamide. We hypothesize that concurrent administration of LuPSMA and enzalutamide will be synergistic in mCRPC. The aims of ENZA-p are to determine the activity and safety of LuPSMA combined with enzalutamide in men with mCRPC at high-risk of early progression on enzalutamide alone; and to identify prognostic and predictive biomarkers from imaging, blood, and tissue. Methods: This open-label, randomized, multicentre, phase 2 trial will recruit 160 men with mCRPC. Key eligibility criteria include progression on androgen deprivation therapy, 2 or more risk factors for early cancer progression on enzalutamide (LDH ≥ULN; ALP ≥ULN; albumin < 35 g/L; M1 disease at diagnosis; < 3 years since initial diagnosis; > 5 bone metastases; visceral metastases; PSA doubling time < 3 months; pain requiring opiates > 14 days; for castration-sensitive disease), no prior treatment with an androgen receptor pathway inhibitor (except abiraterone), no prior chemotherapy for mCRPC, and PSMA-avid disease on positron emission tomography (PET) with 68Ga-PSMA. Participants are randomly assigned (1:1) to enzalutamide 160 mg daily or enzalutamide 160 mg daily plus LuPSMA 7.5 GBq on days 15 and 57. Two subsequent doses of Lu-PSMA will be administered if the 68Ga-PSMA PET on day 92 shows persistent PSMA expression in the tumour. Imaging assessments include CT and technetium bone scan at baseline, day 99, then every 12 weeks; 68Ga-PSMA-11 PET at baseline, days 15, 92, and first progression; and 18F FDG PET at baseline and first progression. Translational samples including circulating tumor cells (CTCs), circulating tumor DNA (ctDNA) and biopsies (optional) will be collected at baseline, day 92, and first progression. The primary endpoint is PSA progression-free survival (PSA-PFS). Secondary endpoints include radiological-PFS, PSA-response rate, pain response and PFS, clinical-PFS, overall survival, health related quality of life, adverse events, and cost-effectiveness. Correlative studies include identification of prognostic and predictive biomarkers from 68Ga-PSMA, 18F FDG PET/CT, CTCs, and ctDNA. A sample size of 160 provides 80% power with a 2-sided type 1- error rate of 5% to detect a HR of 0.625 assuming a median PSA-PFS of 5 months with enzalutamide alone. Accrual was 90 on 12 October 2021. Clinical trial information: NCT04419402.

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Abstract Details

Meeting

2022 ASCO Genitourinary Cancers Symposium

Session Type

Trials in Progress Poster Session

Session Title

Trials in Progress Poster Session A: Prostate Cancer

Track

Prostate Cancer - Advanced,Prostate Cancer - Localized

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT04419402

Citation

J Clin Oncol 40, 2022 (suppl 6; abstr TPS205)

DOI

10.1200/JCO.2022.40.6_suppl.TPS205

Abstract #

TPS205

Poster Bd #

Online Only

Abstract Disclosures