MC# 19-30 - Phase Ib/II Open-Label Study Evaluating Tazemetostat in Combination with Enzalutamide or Abiraterone/Prednisone in Chemotherapy Naive Subjects with Metastatic Castration Resistant Prostate Cancer

  • Agent(s): Tazemetostat
  • Disease Type(s): Prostate
  • Phase(s): I, II
  • Drug Classification(s): Targeted Therapy, Small Molecule
  • Molecular Target(s): EZH2

Mechanism of Action

Tazemetostat selectively inhibits the activity of both wild-type and mutated forms of EZH2 which prevents the methylation of histone H3 lysine 27 (H3K27). This decrease in histone methylation alters gene expression patterns associated with cancer pathways and results in decreased tumor cell proliferation in EZH2 mutated cancer cells. This drug will be combined with Abiraterone and Enzalutamide.

Purpose

In this study, the sponsor and investigators want to learn:

  • How much of tazemetostat can be given with an acceptable level of side effects
  • The effects of tazemetostat (good and bad)
  • How much of tazemetostat is absorbed into the blood and how fast it is removed
  • If research tests can be used in the future to predict who will benefit from tazemetostat
Inclusion Criteria
  • Age at the time of consent ≥ 18 years
  • Eastern Cooperative Oncology Group (ECOG) performance status 0 to 1
  • Life expectancy of > 3 months
  • Histologically or cytologically confirmed adenocarcinoma of the prostate.  Small cell or neuroendocrine tumors of the prostate are also permitted.
  • Progressive disease in the setting of medical or surgical castration (ie, CRPC) by PCWG3 criteria for study entry
    • Evidence of disease progression by rising PSA or
    • Soft tissue progression per mRECIST 1.1 or
    • Evidence of disease progression by observation of 2 new bone lesions since the initiation of last systemic therapy
  • Metastatic prostate cancer disease, documented by imaging
  • Must have undergone bilateral orchiectomy (surgical castration) or be willing to continue GnRH analog or antagonist (medical castration)
  • Surgically or medically castrated, with serum testosterone ≤50 ng/dL (≤ 1.73 nmol/L) at screening
  • Previously untreated with or progressed on a second generation androgen inhibitor (abiraterone, enzalutamide, or apalutamide)
  • No prior treatment with cytotoxic chemotherapy for mCRPC is permitted.  Up to six prior cycles of docetaxel received for castration-sensitive disease is permitted for those subjects prior to receiving enzalutamide or abiraterone/prednisone.
  • Demonstrate adequate organ function as defined below:
    • ANC ≥ 1,000 /μL
    • Platelet Count ≥ 100,000 /μL
    • Hemoglobin ≥ 9 g/dL without a transfusion within 2 weeks of screening
    • Serum creatinine ≤ 2 × upper limit of normal (ULN) or            
      • Creatinine clearance ≥ 40 mL/min as estimated by the Cockcroft and Gault formula in subjects with creatinine > 2 × ULN
    • Bilirubin ≤ 1.5 × ULN unless evidence of Gilbert's disease in which case < 3 × ULN
    • AST ≤ 2.5 × ULN without liver metastases; must be ≤ 5 × ULN with liver metastases
    • ALT ≤ 2.5 × ULN without liver metastases; must be ≤ 5 × ULN with liver metastases
    • Albumin >3.0 g/dL (30 g/L) at screening
Exclusion Criteria
  • Known symptomatic brain metastases
  • Untreated or impending spinal cord compression
  • Treatment with any of the following for prostate cancer within the indicated timeframe prior to day 1 of starting study treatment:
    • First generation: AR antagonists (eg, bicalutamide, nilutamide, flutamide) within 4 weeks
    • 5 alpha reductase inhibitors, ketoconazole, estrogens (including diethylstilbesterol), or progesterones within 2 weeks
    • Chemotherapy within 3 weeks
    • Prior radionuclide therapy within 4 weeks
  • Severe concurrent disease, infection, or co-morbidity that, in the judgment of the Investigator, would make the subject inappropriate for enrollment
  • History of another invasive cancer within 3 years of randomization, with the exception of treated non-melanoma skin cancer, treated superficial bladder cancer, or fully treated cancers with a remote probability of recurrence in the opinion of both the Medical Monitor and Investigator
  • History of seizure or any condition that may predispose to seizure (eg, prior cortical stroke or significant brain trauma).  History of sub clinical seizures manifested by loss of consciousness or transient ischemic attack within 12 months of randomization. However, subjects on medications with seizure lowering threshold will be admitted.
  • Clinically significant cardiovascular disease including the following:
    • Myocardial infarction within 6 months before screening
    • Uncontrolled angina within 3 months before screening
    • Congestive heart failure (New York Heart Association class 3 or 4), or a history of congestive heart failure (New York Heart Association class 3 or 4), unless a screening echocardiogram or multigated acquisition scan performed within 3 months before randomization demonstrates a left ventricular ejection fraction ≥50%
    • History of clinically significant ventricular arrhythmias (eg, sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes)
    • History of Mobitz 2 second-degree or third-degree heart block without a permanent pacemaker in place
    • Hypotension as indicated by systolic blood pressure <86 millimeters of mercury (mmHg) at screening
    • Bradycardia as indicated by a heart rate of <45 beats per minute on the screening electrocardiogram (ECG), and upon physical examination
    • Uncontrolled hypertension as indicated by systolic blood pressure >170 mmHg or diastolic blood pressure >105 mmHg at screening
  • Gastrointestinal disorder affecting absorption (eg, gastrectomy, active peptic ulcer disease within 3 months before randomization)
  • Major surgery within 4 weeks of randomization
  • For subjects taking abiraterone and prednisone, no evidence of hepatic impairment
  • Hypersensitivity reaction to the active pharmaceutical ingredient of tazemetostat, abiraterone, prednisone, or enzalutamide, or any of the other components of each individual agent under study
  • Is unwilling to exclude grapefruit juice, Seville oranges and grapefruit from the diet and all foods that contain those fruits from time of enrollment to while on study
  • Is currently taking any prohibited medication(s) as described in the protocol
  • Has had prior exposure to tazemetostat or other inhibitor(s) of EZH2
  • Is immunocompromised (ie, has a congenital immunodeficiency.  Subjects diagnosed with human immunodeficiency virus (HIV) are eligible to participate in the study if they meet the following criteria:
    • No history of AIDS-defining opportunistic infections, or have not had an opportunistic infection within the 12 months prior to enrollment
    • No history of AIDS-defining cancers (eg, Kaposi’s sarcoma, aggressive B-cell lymphoma, and invasive cervical cancer)
    • Subjects may take prophylactic antimicrobials; however, subjects taking specific antimicrobial drugs that have a potential for drug-drug interaction or overlapping toxicities with study drugs must be excluded from study participation
    • Subjects should be on established anti-retroviral therapy for ≥4 weeks with an HIV viral load of < 400 copies/mL and/or CD4+ T-cell (CD4+) count ≥350 cells/uL prior to enrollment
  • Has thrombocytopenia, neutropenia, or anemia of Grade ≥3 (per CTCAE 5.0 criteria) or any prior history of myeloid malignancies, including MDS.  Has abnormalities known to be associated with MDS (eg, del 5q, chr 7 abn) and MPN (eg, JAK2 V617F) observed in cytogenetic testing and DNA sequencing.
    • NOTE: Bone marrow aspirate/biopsy will be conducted following abnormal peripheral blood smear morphology assessment conducted by central laboratory.  Cytogenetic testing and DNA sequencing will be conducted following an abnormal result of bone marrow aspirate/biopsy.
  • Has a prior history of T-LBL/T-ALL
  • Is unable to take oral medications or has malabsorption syndrome or any other uncontrolled gastrointestinal condition (eg, nausea, diarrhea or vomiting) that might impair the bioavailability of study treatments.
  • Subjects with hepatitis B or hepatitis C are ineligible to participate in the study unless they meet the following criteria:
    • Do not have uncontrolled hepatitis B or C infection, are not on active immunosuppressive therapy, and do not have a history of autoimmune disease requiring ongoing systemic therapy
    • Subjects taking therapy for hepatitis where there may be a drug-drug interaction or overlapping toxicities with study drugs must be excluded from study participation

Location

  • Dallas, TX - Mary Crowley Cancer Research - Medical City

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Re: MC# 19-30