Docetaxel and Prednisone With or Without Bevacizumab in Treating Patients With Prostate Cancer That Did Not Respond to Hormone Therapy

Condition(s) targeted: Prostate Cancer

Intervention: bevacizumab (Drug); docetaxel (Drug); placebo (Drug); prednisone (Drug)

Phase: Phase 3

Status: Active, not recruiting

Sponsored by: Cancer and Leukemia Group B

Official(s) and/or principal investigator(s):
William K. Kelly, DO, Study Chair, Affiliation: Yale University
Michael A. Carducci, MD, Study Chair, Affiliation: Sidney Kimmel Comprehensive Cancer Center

RATIONALE: Drugs used in chemotherapy, such as docetaxel and prednisone, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. It is not yet known whether docetaxel, prednisone, and bevacizumab are more effective than docetaxel and prednisone in treating prostate cancer.

PURPOSE: This randomized phase III trial is studying docetaxel, prednisone, and bevacizumab to see how well they work compared to docetaxel and prednisone in treating patients with prostate cancer that did not respond to hormone therapy.

Official title: A Randomized Double-Blinded Placebo Controlled Phase III Trial Comparing Docetaxel and Prednisone With and Without Bevacizumab (IND #7921, NSC #704865) In Men With Hormone Refratory Prostate Cancer

Study design: Treatment, Randomized, Double-Blind, Placebo Control

Primary outcome: Overall survival

Secondary outcome:

Proportion of patients who experience a 50% post-treatment prostate-specific antigen (PSA) decline from baseline

Progression-free survival (PFS)

Biochemical (PSA) PFS

Toxicity

Detailed description: OBJECTIVES:

Primary

- Compare overall survival of patients with hormone-refractory metastatic adenocarcinoma

of the prostate treated with docetaxel and prednisone with vs without bevacizumab.

Secondary

- Compare progression-free survival of patients treated with these regimens.

- Compare the proportion of patients treated with these regimens who experience a 50%

post-treatment prostate-specific antigen decline from baseline.

- Compare the proportion of patients treated with these regimens who experience ≥ grade 3

toxic effects.

OUTLINE: This is a randomized, double-blind, placebo-controlled, multicenter study. Patients are stratified according to predicted 24-month survival probability (< 10% vs 10-29. 9% vs ≥ 30%), age (< 65 years vs ≥ 65 years), and prior history of arterial events (i. e., cardiac ischemia/infarction, CNS cerebrovascular ischemia, peripheral arterial ischemia, or CNS hemorrhage) (yes vs no). Patients are randomized to 1 of 2 treatment arms.

- Arm I: Patients receive docetaxel IV over 1 hour and placebo IV over 30-90 minutes on

day 1. Patients also receive oral prednisone once daily on days 1-21.

- Arm II: Patients receive docetaxel and prednisone as in arm I. Patients also receive

bevacizumab IV over 30-90 minutes on day 1.

In both arms, courses repeat every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed periodically for up to 5 years.

PROJECTED ACCRUAL: Approximately 1,020 patients (510 per treatment arm) will be accrued for this study within 3 years.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Male.

Criteria:

DISEASE CHARACTERISTICS:

- Histologically confirmed adenocarcinoma of the prostate

- Clinically metastatic disease by bone scan, CT scan, or MRI

- Meets 1 of the following criteria:

- Measurable disease with any level of prostate-specific antigen (PSA)

- At least 1 unidimensionally measurable lesion ≥ 20 mm by conventional

techniques (i. e., physical exam or chest x-ray) OR ≥ 10 mm by spiral CT scan or MRI

- Nonmeasurable disease AND PSA ≥ 5 ng/mL

- The following are considered nonmeasurable disease:

- Bone lesions

- Pleural or pericardial effusions or ascites

- CNS lesions or leptomeningeal disease

- Irradiated lesions unless disease progression is documented after

radiotherapy

- Patients with PSA ≥ 5 ng/mL only and no other radiographic evidence of

metastatic prostate cancer are not eligible

- Progressive systemic disease (since the most recent change in therapy) despite

castrate levels of testosterone due to orchiectomy or luteinizing hormone-releasing hormone (LHRH) agonist therapy

- Castrate levels of testosterone must be maintained

- Primary testicular androgen suppression (e. g.,LHRH agonists) should be

continued during study treatment for patients who have not had a bilateral orchiectomy

- Progressive disease is defined as any of the following:

- Measurable disease progression

- Increase of > 20% in the sum of the longest diameters of target lesions

from the time of maximal regression OR the appearance of ≥ 1 new lesion

- Bone scan progression

- Appearance of ≥ 1 new lesion on bone scan attributable to prostate

cancer AND PSA ≥ 5 ng/mL

- PSA progression

- PSA ≥ 5 ng/mL that has risen serially from baseline on at least 2

occasions (taken ≥1 week apart) after the discontinuation of antiandrogen therapy

- If the confirmatory PSA value is < the screening PSA value, an

additional test for rising PSA is required to document progression

- Testosterone ≤ 50 ng/dL for patients who have not had a bilateral orchiectomy

- Have an established Gleason sum

- Patients enrolled on CALGB-90202 are eligible provide they have documented disease

progression and have received ≥ 4 weeks of open-label zoledronic acid treatment

- No known brain metastases (MRI or CT scan is not required)

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-2

Life expectancy

- Not specified

Hematopoietic

- Absolute neutrophil count ≥ 1,500/mm^3

- Platelet count ≥ 100,000/mm^3

- No other significant bleeding episode within the past 6 months

Hepatic

- Bilirubin ≤ 1. 5 times upper limit of normal (ULN)

- AST ≤ 1. 5 times ULN

Renal

- Creatinine ≤ 1. 5 times ULN

- Urine protein to creatinine ratio < 1. 0

Cardiovascular

- History of hypertension allowed provided blood pressure (BP) is controlled (i. e., BP <

160/90 mm Hg) by anti-hypertensive therapy

- No New York Heart Association class II-IV congestive heart failure

- No arterial thrombotic events within the past 6 months, including any of the

following:

- Transient ischemic attack

- Cerebrovascular accident

- Unstable angina

- Angina requiring surgical or medical intervention

- Myocardial infarction

- Clinically significant peripheral artery disease (i. e., claudication on less than

1 block)

- Any other arterial thrombotic event

Pulmonary

- No hemoptysis within the past 6 months

Gastrointestinal

- No upper or lower gastrointestinal (GI) bleeding within the past 6 months

- No history of GI perforation within the past 12 months

Other

- Fertile patients must use effective contraception during and for at least 3 months

after completion of study treatment

- No serious or non-healing wound, ulcer, or bone fracture

- No peripheral neuropathy ≥ grade 2

- No known hypersensitivity to Chinese hamster ovary cell products or other recombinant

human antibodies

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No prior thalidomide or bevacizumab

- No other prior antiangiogenesis agents

- No concurrent prophylactic filgrastim (G-CSF), pegfilgrastim, or sargramostim

(GM-CSF)

Chemotherapy

- No prior estramustine or suramin

- No other prior cytotoxic chemotherapy

- No other concurrent chemotherapy

Endocrine therapy

- See Disease Characteristics

- At least 4 weeks since prior flutamide, megestrol, bicalutamide, or nilutamide

- At least 4 weeks since any other prior hormonal therapy (e. g., ketoconazole,

aminoglutethimide)

- 5α-reductase inhibitors (e. g., finasteride, dutasteride) may be discontinued any

time prior to study entry

- No concurrent hormonal therapy except for the following:

- Steroids for adrenal insufficiency

- Hormones for non-disease-related conditions (e. g., insulin for diabetes)

- Intermittent dexamethasone as an antiemetic

Radiotherapy

- See Disease Characteristics

- At least 4 weeks since prior radiotherapy, including palliative, and recovered

- At least 8 weeks since prior strontium chloride Sr 89 or samarium Sm 153 lexidronam

pentasodium

- No concurrent palliative radiotherapy

Surgery

- See Disease Characteristics

- At least 4 weeks since prior major surgery and recovered

Other

- Concurrent bisphosphonates allowed provided patient is on a stable dose and initiated

treatment ≥ 4 weeks prior to study entry

- No initiation of bisphosphonates during study treatment

- Concurrent full-dose anticoagulation allowed provided patient is on a stable dose of

warfarin AND has an in-range INR OR patient is on a stable dose of low-molecular weight heparin

- Concurrent antiplatelet agents allowed, including daily prophylactic aspirin or

anticoagulation for atrial fibrillation

- No concurrent herbal medications or food supplements (e. g., PC-SPES, saw palmetto, or

Hypericum perforatum [St. John's wort])

- Concurrent daily vitamins and calcium supplements allowed

Mayo Clinic Scottsdale, Scottsdale, Arizona 85259-5499, United States

Aurora Presbyterian Hospital, Aurora, Colorado 80012, United States

Boulder Community Hospital, Boulder, Colorado 80301-9019, United States

CCOP - Colorado Cancer Research Program, Denver, Colorado 80224-2522, United States

Hope Cancer Care Center at Longmont United Hospital, Longmont, Colorado 80502, United States

North Suburban Medical Center, Thornton, Colorado 80229, United States

Penrose Cancer Center at Penrose Hospital, Colorado Springs, Colorado 80933, United States

Porter Adventist Hospital, Denver, Colorado 80210, United States

Presbyterian - St. Luke's Medical Center, Denver, Colorado 80218, United States

Rose Medical Center, Denver, Colorado 80220, United States

Sky Ridge Medical Center, Lone Tree, Colorado 80124, United States

St. Joseph Hospital, Denver, Colorado 80218, United States

St. Mary - Corwin Regional Medical Center, Pueblo, Colorado 81004, United States

Swedish Medical Center, Englewood, Colorado 80110, United States

Mayo Clinic - Jacksonville, Jacksonville, Florida 32224, United States

MBCCOP - Medical College of Georgia Cancer Center, Augusta, Georgia 30912, United States

Veterans Affairs Medical Center - Augusta, Augusta, Georgia 30904, United States

Holden Comprehensive Cancer Center at University of Iowa, Iowa City, Iowa 52242-1002, United States

McCreery Cancer Center at Ottumwa Regional, Ottumwa, Iowa 52501, United States

Mayo Clinic Cancer Center, Rochester, Minnesota 55905, United States

Center for Cancer Care at Exeter Hospital, Exeter, New Hampshire 03833, United States

CCOP - Hematology-Oncology Associates of Central New York, East Syracuse, New York 13057, United States

Tucker Center for Cancer Care at Orange Regional Medical Center, Middletown, New York 10940-4199, United States

Clinical trial summary from the National Cancer Institute's PDQ® database

Featured trial article

Starting date: April 2005
Last updated: May 23, 2008