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 Medical Center, Kansas City, KS, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, Department of Internal Medicine, University Hospitals Seidman Cancer Center, Cleveland, OH, Montefiore Medical Center, New York, NY, Medical University of South Carolina, Charleston, SC, Alliance Statistics and Data Center and Mayo Clinic, Phoenix, AZ, University of Chicago, Chicago, IL

Research Funding

U.S. National Institutes of Health
U10CA180821, U10CA180882, U24CA196171; U10CA180820 (ECOGACRN); U10CA180868 (NRG); U10CA180888 and UG1CA233178 (SWOG); U.S. National Institutes of Health, Clovis Oncology, Tempus Labs

Background: Despite a growing number of treatment options for first-line mCRPC, approximately 40% of patients (pts) have radiographic progression within the first year. Co-inhibition of androgen receptor (AR) and PARP is a promising therapeutic strategy that leverages synthetic lethality induced by impaired double-strand DNA repair. Two phase III studies have shown improvement in radiographic progression-free survival (rPFS) in HRR-mutant pts with abiraterone + PARPi combinations vs abiraterone alone. However, the results in HRR-wild type pts are conflicting, with only one of the studies demonstrating a benefit with the abiraterone + PARPi combination. ENZ + RUCA has shown an acceptable safety profile & no significant drug-drug interactions (S-DDI) in a phase 1b trial. This allows its evaluation in mCRPC. Methods: CASPAR (A031902) is a phase 3 study in which 984 pts will be randomized on a 1:1 basis to ENZ plus RUCA/PBO. 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 is available). Treatment will be continued until disease progression and 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 non-measurable 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, and no medications with S-DDI with ENZ/RUCA. Hierarchical co-primary endpoints are overall survival (OS) and rPFS. 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 and 21 months in control and combination arms, respectively), and 80% power to detect an HR of 0.80 in OS (median OS of 32 and 40 months, respectively). Key secondary endpoints are rPFS and OS in pts with vs without pathogenic BRCA1, BRCA2, or PALB2 alterations; and differences in adverse events and 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), and EQ-5D-5L. A key correlative endpoint is the sensitivity of ctDNA testing for HRR gene alterations. Enrollment began in July 2021 & the study is available for participation to all US-NCTN sites. Clinical trial information: NCT04455750.

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Abstract Details

Meeting

2023 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

NCT04455750

Citation

J Clin Oncol 41, 2023 (suppl 6; abstr TPS277)

DOI

10.1200/JCO.2023.41.6_suppl.TPS277

Abstract #

TPS277

Poster Bd #

P19

Abstract Disclosures