Phase 4
N=255
Cabazitaxel Versus the Switch to Alternative AR-targeted Agent (Enzalutamide or Abiraterone) in Metastatic Castration-resistant Prostate Cancer (mCRPC) Patients Previously Treated With Docetaxel and Who Rapidly Failed a Prior AR-targeted Agent
Prostate Cancer Metastatic
Bottom Line
View on ClinicalTrials.gov: NCT02485691 ↗Enrolled (actual)
255
Serious AEs
39.6%
Results posted
Feb 2022
Primary outcome: Primary: Radiographic Progression-Free Survival (rPFS) — 8.0; 3.7 months — p=<0.0001
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 4
- Interventions
- cabazitaxel XRP6258 (Drug); enzalutamide (Drug); abiraterone acetate (Drug); prednisone (Drug)
- Age
- Adult, Older Adult · 18+ yrs
- Sex
- Male
- Sponsor
- Sanofi
- Primary completion
- Mar 2019
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Radiographic Progression-Free Survival (rPFS) |
8.0; 3.7 | <0.0001 sig |
| SECONDARY Overall Survival (OS) |
13.6; 11.0 | 0.0078 sig |
| SECONDARY Progression Free Survival (PFS) |
4.4; 2.7 | <0.0001 sig |
| SECONDARY Percentage of Participants With Prostate Specific Antigen (PSA) Response |
36.3; 14.3 | 0.0003 sig |
| SECONDARY Percentage of Participants With Overall Objective Tumor Response |
36.5; 11.5 | 0.0004 sig |
| SECONDARY Time to PSA Progression (TTPP) |
6.3; 2.1 | — |
| SECONDARY Duration of Tumor Response |
6.5; 8.0 | — |
| SECONDARY Percentage of Participants Achieving Pain Response Assessed Using Brief Pain Inventory-Short Form (BPI-SF) Pain Intensity Score |
45.9; 19.3 | — |
| SECONDARY Time to Pain Progression |
NA; 8.5 | — |
| SECONDARY Number of Symptomatic Skeletal Events (SSE) |
24; 35 | — |
| SECONDARY Time to Symptomatic Skeletal Event |
NA; 16.7 | — |
| SECONDARY Health-Related Quality of Life (HRQOL): Change From Baseline in Functional Assessment of Cancer Therapy-Prostate (FACT-P) Total Score at Cycle 2, 3, 4, 5, 6, 7, 8 and End of Treatment |
2.6; -0.0; 2.7; -1.0; 2.8; -0.7 | — |
| SECONDARY Change From Baseline in European Quality of Life Working Group Health Status Measure 5 Dimensions, 5 Levels (EQ-5D-5L) Utility Single Index and Visual Analogue Scale (VAS) Scores at Cycle 2, 3, 4, 5, 6, 7, 8 and End of Treatment |
3.6; 0.9; 4.5; 1.5; 4.6; -1.1 | — |
| SECONDARY Radiographic Progression-Free Survival (rPFS) in Participants With Presence and Absence of Biomarker |
4.2; 4.2; 8.5; 3.4; 3.0; 3.9 | — |
Summary
Primary Objective:
To compare the radiographic progression-free survival (rPFS) (using Response Evaluation Criteria in Solid Tumors [RECIST] 1.1 for tumor lesions and Prostate Cancer Working Group 2 (PCWG2) criteria for bone scan lesions or death due to any cause) with chemotherapy (cabazitaxel plus prednisone, Arm A) versus Androgen Receptor (AR)-targeted therapy (enzalutamide or abiraterone acetate plus prednisone, Arm B) in mCRPC participants who have been treated with docetaxel and who had disease progression while receiving AR-targeted therapy within 12 months of AR treatment initiation (less than or equal to [<=]12 months, either before or after docetaxel).
Secondary Objective:
* To compare efficacy for:
* Prostate-specific antigen (PSA) response rate and time to PSA progression (TTPP).
* Progression-free survival (PFS).
* Overall survival (OS).
* Tumor response rate and duration of tumor response.
* Pain response and time to pain progression.
* Symptomatic skeletal event (SSE) rate and time to occurrence of any SSE.
* Health status and Health-related Quality of Life (HRQOL).
* To evaluate the correlation of a signature of resistance to AR-targeted agents with clinical outcome via the analysis of circulating tumor cell (CTC) phenotypes as well as expression and localization of proteins including AR isoforms in CTCs.
* To evaluate safety in the 2 treatment arms.
Eligibility Criteria
Inclusion criteria
Histologically confirmed prostate adenocarcinoma.
- Metastatic disease.
- Effective castration with serum testosterone levels less than ( 3 years ago.
- Less than 28 days elapsed from prior treatment with chemotherapy, immunotherapy, radiotherapy, or surgery to the time of randomization.
- Adverse events (excluding alopecia and those listed in the specific exclusion criteria) from any prior anticancer therapy of Grade >1 (National Cancer Institute Common Terminology Criteria [NCI CTCAE] v4.0) at the time of randomization.
- Eastern Cooperative Oncology Group performance status (ECOG PS) >2 (ECOG 2 must be related to prostate cancer, not to other comorbidities).
- Prior malignancy. Adequately treated basal cell or squamous cell skin or superficial (pTis, pTa, and pT1) bladder cancer were allowed, as well as any other cancer for which treatment has been completed >=5 years ago and from which the participant has been disease-free for >=5 years.
- Participation in another clinical trial and any concurrent treatment with any investigational drug within 30 days prior to randomization.
- Acquired immunodeficiency syndrome (AIDS-related illnesses) or known human immunodeficiency virus (HIV) disease requiring antiretroviral treatment.
- Participants with reproductive potential who do not agree, in conjunction with their partner, to use accepted and effective method of contraception during the study treatment period and up to 6 months after the last administered dose. The definition of "effective method of contraception" described hereafter: oral contraceptives, combined hormonal intravaginal, transdermal, intra uterine device or condoms was based on respective study treatment labelling and country-specific regulatory requirements, and were documented in the Informed Consent Form.
- Known allergies, hypersensitivity or intolerance to prednisone or excipients of abiraterone acetate, enzalutamide, docetaxel, or polysorbate 80.
- Known history of mineralocorticoid excess or deficiency.
- History of seizure, underlying brain injury with loss of consciousness, transient ischemic attack within the past 12 months, cerebral vascular accident, brain arteriovenous malformation, brain metastases, or the use of concomitant medications that may lower the seizure threshold.
- Unable to swallow a whole tablet or capsule.
- Inadequate organ and bone marrow function as evidenced by:
- Hemoglobin 1.5 * the upper limit of normal (ULN);
- Total bilirubin >1.0 * ULN;
- Potassium =2 (NCI CTCAE v4.0).
- Uncontrolled severe illness or medical condition including uncontrolled diabetes mellitus, history of cardiovascular disease (uncontrolled hypertension, arterial thrombotic events in the past 6 months, congestive heart failure, severe or unstable angina pectoris, recent myocardial infarction within the last 6 months, or uncontrolled cardiac arrhythmia).
- Concomitant vaccination with yellow fever vaccine.
The above information was not intended to contain all considerations relevant to a participant's potential participation in a clinical trial.
Data sourced from ClinicalTrials.gov (NCT02485691). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.