Mitoxantrone, Prednisone Plus Sorafenib in Taxane-Refractory Metastatic Hormone Refractory Prostate Cancer (HRPC)

Condition(s) targeted: Metastatic Prostate Cancer

Intervention: Mitoxantrone (Drug); Prednisone (Drug); Sorafenib (Drug)

Phase: Phase 2

Status: Active, not recruiting

Sponsored by: Accelerated Community Oncology Research Network

Official(s) and/or principal investigator(s):
Vasily Assikis, MD, Principal Investigator, Affiliation: Peachtree Hematology Oncology Consultants

The purpose of this research study is to determine if the combination of mitoxantrone, prednisone and sorafenib will improve the time to progression of advanced stage metastatic hormone-refractory prostate cancer.

Official title: Mitoxantrone, Prednisone Plus Sorafenib in Taxane-Refractory Metastatic Hormone Refractory Prostate Cancer (HRPC)

Study design: Treatment, Non-Randomized, Open Label, Historical Control, Single Group Assignment, Safety/Efficacy Study

Primary outcome: Establish median time to progression (TTP) by imaging

Secondary outcome:

Assess toxicity of this regimen

Correlation of biochemical criteria (PSA) with objective imaging

Assess quality of life (QoL)

Establish median overall survival (OS)

Detailed description: The primary objective of this study is to test the hypothesis that the combination of Mitoxantrone, Prednisone and Sorafenib in taxane-refractory patients with mHRPC will result in an improvement of the median time to progression (TTP). Since the median (i. e 50% of patients) TTP for Mitoxantrone/Prednisone is 3 months, our hypothesis is that 70% will have not progressed at 3 months with this investigational combination. Progression will be assessed by radiologic imaging criteria.

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

Criteria:

Inclusion Criteria:

- Voluntary written informed consent

- Histopathologic diagnosis of prostatic adenocarcinoma with evidence of progression

despite adequate castration (testosterone < 50 ng/dL)

- Progressive disease after taxane-based chemotherapy (docetaxel or paclitaxel, single

agent or combination regimens, weekly or q 21d schedules)

- Patients who discontinued taxane- based chemotherapy because of toxicity will be

eligible as long as there is evidence of progressive disease

- Minimum of 4 weeks period from last chemotherapy infusion to registration (this does

not apply to steroid use which is permitted). Estramustine needs to be discontinued at least 6 weeks prior to first day of treatment on protocol

- A minimum of 4 weeks off bicalutamide, nilutamide, megestrol acetate ketoconazole,

DES. Minimum of 2 weeks off flutamide

- Reductase inhibitors will be allowed if initiated at least 2 months prior to

registration

- No concurrent investigational therapy

- Complementary and Alternative Medicine (CAM) products will be permitted as long as

patients have been receiving them for at least 2 months. Initiation of new CAM products while on protocol will be discouraged.

- Ongoing androgen deprivation therapy (orchiectomy, GnRH agonist or antagonist)

- Adequate bone marrow, liver and renal function as assessed by the following:

- Hemoglobin ≥ 9. 0 g/dl

- Absolute neutrophil count (ANC) ≥ 1,500/mm3

- Platelet count ≥ 100,000/mm3

- Total bilirubin ≤ 1. 5 times ULN

- ALT and AST ≤ 2. 5 times the ULN ( < 5 x ULN for patients with liver involvement)

- Creatinine ≤ 1. 5 times the ULN

- INR < 1. 5 or a PT/PTT within normal limits. Patients receiving anti-coagulation

treatment with an agent such as warfarin or heparin may be allowed to participate. For patients on warfarin, the INR should be measured prior to initiation of sorafenib and monitored at least weekly, or as defined by the local standard of care, until INR is stable.

- ECOG performance status ≤ 2

- Baseline LVEF ≥ 50%

- Life expectancy ≥ 3 months

- Patients must agree to use adequate contraception prior to study entry, during the

study and for at least three months after the last administration of sorafenib

Exclusion Criteria:

- More than one line of prior cytotoxic chemotherapy in the metastatic setting, previous

adjuvant chemotherapy will be allowed

- No active malignancy other than prostate cancer (except non-melanoma skin cancer)

within 5 years of enrollment

- Known brain metastases

- Cardiac disease: Congestive heart failure > class II NYHA. Patients must not have

unstable angina or new onset angina (began within the last 3 months) or myocardial infarction within the past 6 months

- Cardiac ventricular arrhythmias requiring anti-arrhythmic therapy

- Uncontrolled hypertension

- Active clinically serious infection > CTCAE Grade 2

- Thrombolic or embolic events such as a cerebrovascular accident including transient

ischemic attacks within the past 6 months

- Pulmonary hemorrhage/bleeding event ≥ CTCAE Grade 2 within 4 weeks of first dose of

study drug

- Any other hemorrhage/bleeding event ≥ CTCAE Grade 3 within 4 weeks of first dose of

study drug

- Poorly controlled hyperglycemia

- Treatment with radiotherapy within 4 weeks or treatment with radiopharmaceuticals

within past 8 weeks

- Patient has received other investigational drugs within 14 days before enrollment

- Serious medical or psychiatric illness likely to interfere with participation in this

clinical study

- Serious non-healing wound or ulcer

- Evidence or history of bleeding diathesis or coagulopathy

- Use of St. John's Wort or rifampin

- Known or suspected allergy to sorafenib or any agent given in the course of this

trial

- Any condition that impairs patient's ability to swallow whole pills

- Any malabsorption problem

Wilshire Oncology Medical Group, Inc., La Verne, California 91750, United States

Central Georgia Cancer Care, Macon, Georgia 31201, United States

Northwest Georgia Oncology Centers, Marietta, Georgia 30060, United States

Peachtree Hematology Oncology Consultants, Atlanta, Georgia 30309, United States

Hematology Oncology Centers of the Northern Rockies, PC, Billings, Montana 59101, United States

Mid-Ohio Oncology/Hematology, Inc., Columbus, Ohio 43213, United States

Lancaster Cancer Center, Lancaster, Pennsylvania 17605, United States

Pennsylvania Oncology Hematmology Associates, Philadelphia, Pennsylvania 19106, United States

The West Clinic, Memphis, Tennessee 38120, United States

Cancer Specialists of Tidewater, Chesapeake, Virginia 23320, United States

Starting date: May 2007
Last updated: March 31, 2008