Sorafenib in Treating Patients With Metastatic or Recurrent Prostate Cancer

NCIC Clinical Trials Group

Status and phase: Completed; Phase 2

Conditions: Prostate Cancer

Treatments: Drug: sorafenib tosylate

Study type: Interventional

Funder types: NETWORK; NIH

Identifiers

NCT00093457

I167

CDR0000387987 (Other Identifier)

CAN-NCIC-IND167 (Other Identifier)

Details and patient eligibility

About

RATIONALE: Sorafenib may stop the growth of tumor cells by blocking the enzymes necessary for their growth.

PURPOSE: This phase II trial is studying the effectiveness of sorafenib in treating patients who have metastatic or recurrent prostate cancer that has not responded to previous hormone therapy.

Full description

OBJECTIVES:

• Determine the efficacy of sorafenib, as measured by prostate-specific antigen response, in patients with metastatic or recurrent hormone-refractory adenocarcinoma of the prostate.

Secondary

• Determine the objective response rate and duration of response in patients treated with this drug.
• Determine the tolerability and toxicity of this drug in these patients.
• Determine time to treatment failure and overall survival in patients treated with this drug.
• Explore the relationship between measures of ras/raf pathway activation (pERK) and response to treatment in these patients.

OUTLINE: This is a non-randomized, multicenter study.

Patients receive oral sorafenib twice daily on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

Patients are followed at 4 weeks after going off study treatment and then periodically for survival. Patients with stable or responding disease, when they go off study treatment, are followed every 3 months until relapse or progression.

PROJECTED ACCRUAL: Approximately 15-25 patients will be accrued for this study within 12-18 months.

Enrollment: 28 patients

Sex: Male

Ages: 18 to 120 years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed adenocarcinoma of the prostate

  • Metastatic or recurrent disease

• No curative standard therapy exists

• Hormone-refractory disease

  • Evidence of prostate-specific antigen (PSA) progression during androgen ablation therapy, including medical or surgical castration

    • Documented PSA progression after completion of prior peripheral anti-androgens

      • At least a 25% increase (≥ 5 ng/mL) over a reference value PSA with 2 consecutive rising PSAs taken ≥ 1 week apart

    • Castrate level of testosterone ≤ 1.7 nmol/L for patients on medical androgen ablation

      • Patients receiving luteinizing hormone-releasing hormone agonist therapy must continue this treatment during study participation

• PSA ≥ 10 ng/mL at the time of study entry

• Primary tumor tissue (paraffin embedded) must be available for immunohistochemistry

• Minimal symptomatic disease

  • No requirement for morphine or equivalent dose > 30 mg/day to control pain

• No known brain metastases

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• At least 12 weeks

Hematopoietic

• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 100,000/mm^3
• No evidence of bleeding diathesis

Hepatic

• Bilirubin normal
• AST and ALT ≤ 2.5 times upper limit of normal

Renal

• Serum creatinine normal OR
• Creatinine clearance ≥ 60 mL/min

Cardiovascular

• No myocardial infarction within the past 6 months
• No congestive heart failure
• No unstable angina
• No active cardiomyopathy
• No unstable ventricular arrhythmia
• No uncontrolled hypertension

Other

• No serious infection
• No active peptic ulcer disease
• No upper gastrointestinal or other condition that would preclude study compliance with oral medication
• No uncontrolled psychotic disorder
• No history of allergic reaction attributed to compounds of similar chemical or biologic composition to sorafenib or other study agents
• No other serious illness or medical condition that would preclude study participation
• No other malignancy within the past 5 years except adequately treated non-melanoma skin cancer or other curatively treated solid tumor

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Concurrent prophylactic filgrastim (G-CSF), sargramostim (GM-CSF), or other growth factors allowed for the management of adverse events only

Chemotherapy

• No prior chemotherapy
• No other prior cytotoxic chemotherapy

Endocrine therapy

• See Disease Characteristics
• Concurrent steroids allowed provided there has been no increase in steroid requirements within the past 4 weeks AND no increase in dose is planned

Radiotherapy

• At least 4 weeks since prior external-beam radiotherapy except low-dose non-myelosuppressive radiotherapy
• Concurrent low-dose non-myelosuppressive palliative radiotherapy allowed

Surgery

• Not specified

Other

• No prior investigational anticancer agents

• No concurrent therapeutic anticoagulation

  • Concurrent prophylactic low-dose warfarin for venous or arterial access devices allowed

• No concurrent combination antiretroviral therapy for HIV-positive patients

• No other concurrent anticancer therapy

• No other concurrent investigational therapy

• No concurrent grapefruit juice

• Concurrent bisphosphonates allowed

Trial design

Primary purpose: Treatment

Allocation: Non-Randomized

Interventional model: Single Group Assignment

Masking: None (Open label)