Alliance A031902 (CASPAR): A randomized, phase (ph) 3 trial of enzalutamide with rucaparib/placebo in first-line metastatic castration-resistant prostate cancer (mCRPC).

Authors

Arpit Rao

Arpit Rao

Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX

Arpit Rao , Glenn Heller , Charles J. Ryan , David James VanderWeele , Lionel D Lewis , Alan Tan , Colleen Watt , Ronald C. Chen , Manish Kohli , Pedro C. Barata , Benjamin Adam Gartrell , Robert Grubb , Amylou C. Dueck , Yujia Wen , Michael J. Morris

Organizations

Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, Memorial Sloan Kettering Cancer Center, New York, NY, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, Northwestern University, Chicago, IL, Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH, Rush University Medical Center, Chicago, IL, Alliance for Clinical Trials in Oncology, Chicago, IL, University of Kansas, Kansas City, KS, Huntsman Cancer Institute, Salt Lake City, UT, Tulane University Medical School, New Orleans, LA, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, Medical University of South Carolina, Charleston, SC, Alliance Statistics and Data Center and Mayo Clinic, Phoenix, AZ, Univ of Chicago, Chicago, IL, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY

Research Funding

U.S. National Institutes of Health
Clovis Oncology

Background: Despite a growing number of treatment options for first line mCRPC, approximately 40% of patients (pts) have radiographic progression within the first year. Androgen receptor (AR) signaling inhibition increases genomic instability with double-strand DNA breaks & co-inhibition of AR & PARP induces synthetic lethality in multiple preclinical models. Homologous recombination repair (HRR) gene aberrations do not appear to be necessary for this synergy as demonstrated in a ph 3 clinical trial of abiraterone & olaparib where this combination improved radiographic progression-free survival (rPFS) in HRR-wild-type pts compared with abiraterone alone. A ph 1b trial has since shown that enzalutamide plus rucaparib has acceptable safety profile & no significant drug-drug interactions (S-DDI). Methods: CASPAR/A031902 (NCT04455750) is a ph 3 study in which 984 pts will be randomized 1:1 to enzalutamide plus rucaparib or placebo. HRR gene aberration is not required for enrollment. All pts will undergo next-generation targeted-exome sequencing from archival tumor tissue (new biopsy only required if no archival tissue available). Treatment will be continued until disease progression & crossover is not allowed. Key eligibility criteria are age ≥ 18 years, ECOG PS 0-2, biopsy-proven prostate adenocarcinoma, progressive (PSA or radiographic) disease per Prostate Cancer Working Group 3 guidelines, measurable or nonmeasurable disease per RECIST 1.1, no prior treatment for mCRPC (prior docetaxel, abiraterone, darolutamide, or apalutamide in non-mCRPC setting is allowed), no significant uncontrolled comorbidity, & no medications with S-DDI with enzalutamide/rucaparib. Hierarchical co-primary endpoints are rPFS & overall survival (OS). The OS analysis will be undertaken as a primary endpoint if the rPFS endpoint is met. For a one-sided logrank test with a type 1 error rate equal to 0.025, the study has 90% power to detect a hazard ratio (HR) of 0.71 in rPFS (median rPFS of 15 & 21 months in control & combination arms, respectively) & 80% power to detect an HR of 0.80 in OS (median OS of 32 & 40 months, respectively). Key secondary endpoints are rPFS & OS in pts with vs without pathogenic BRCA1, BRCA2, or PALB2 alterations; & differences in adverse events & quality of life (QOL) outcomes between the treatment arms. QOL assessments include Functional Assessment of Cancer Therapy–Prostate (FACT-P), Brief Pain Inventory Short Form (BPI-SF) & EQ-5D-5L. A key correlative endpoint is the sensitivity of ctDNA-based testing for alterations in HRR genes. Enrollment to CASPAR began in July 2021 & the study is available for participation to all US-NCTN sites with a projected enrollment of 3 years. Support: U10CA180821, U10CA180882, U24CA196171; U10CA180888. Clinical trial information: NCT04455750.

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Abstract Details

Meeting

2022 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Genitourinary Cancer—Prostate, Testicular, and Penile

Track

Genitourinary Cancer—Prostate, Testicular, and Penile

Sub Track

Prostate Cancer– Advanced/Castrate-Resistant

Clinical Trial Registration Number

NCT04455750

Citation

J Clin Oncol 40, 2022 (suppl 16; abstr TPS5107)

DOI

10.1200/JCO.2022.40.16_suppl.TPS5107

Abstract #

TPS5107

Poster Bd #

283a

Abstract Disclosures