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

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.

Study Type: Interventional

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

Study Primary Completion Date: April 2008

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.

Intervention(s) in this Clinical Trial

• Drug: Mitoxantrone
  • Once six patients are accrued at dose level 1, MTD will be assessed by following them through one cycle of treatment. If 2/6 patients experience dose limiting toxicity (DLT) at the 400 mg bid level then the MTD will be defined as 400 mg QD. Additional patients will be enrolled at the MTD for the phase II portion. Dose Level -2, Mitoxantrone 9mg/m2 Dose Level -1 Mitoxantrone 12mg/m2 Dose Level 1 Mitoxantrone 12mg/m2
• Drug: Prednisone
  • Once six patients are accrued at dose level 1, MTD will be assessed by following them through one cycle of treatment. If 2/6 patients experience dose limiting toxicity (DLT) at the 400 mg bid level then the MTD will be defined as 400 mg QD. Additional patients will be enrolled at the MTD for the phase II portion. Dose Level -2, Prednisone 5mg bid Dose Level -1 Prednisone 5mg bid Dose Level 1 Prednisone 5mg bid
• Drug: Sorafenib
  • Once six patients are accrued at dose level 1, MTD will be assessed by following them through one cycle of treatment. If 2/6 patients experience dose limiting toxicity (DLT) at the 400 mg bid level then the MTD will be defined as 400 mg QD. Additional patients will be enrolled at the MTD for the phase II portion. Dose Level -2, Sorafenib 400 mg QD Dose Level -1 Sorafenib 400 mg QD Dose Level 1 Sorafenib 400 mg bid

Arms, Groups and Cohorts in this Clinical Trial

• Experimental: 1
  • Once six patients are accrued at dose level 1, MTD will be assessed by following them through one cycle of treatment. If 2/6 patients experience dose limiting toxicity (DLT) at the 400 mg bid level then the MTD will be defined as 400 mg QD. Additional patients will be enrolled at the MTD for the phase II portion. Dose Level -2, Mitoxantrone 9mg/m2 + Prednisone 5mg bid Sorafenib 400 mg QD Dose Level -1 Mitoxantrone 12mg/m2 + Prednisone 5mg bid Sorafenib 400 mg QD Dose Level 1 Mitoxantrone 12mg/m2 + Prednisone 5mg bid Sorafenib 400 mg bid

Primary Measures

• Establish median time to progression (TTP) by imaging
  • Time Frame: Every 12 Weeks
    Safety Issue?: No

Secondary Measures

• Assess toxicity of this regimen
  • Time Frame: Every 3 Weeks
    Safety Issue?: Yes
• Correlation of biochemical criteria (PSA) with objective imaging
  • Time Frame: Every 3 Weeks
    Safety Issue?: Yes
• Assess quality of life (QoL)
  • Time Frame: Every 3 Weeks
    Safety Issue?: No
• Establish median overall survival (OS)
  • Time Frame: Every 3 months until death
    Safety Issue?: No

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

Gender Eligibility for this Clinical Trial: Male

Minimum Age for this Clinical Trial: 18 Years

Maximum Age for this Clinical Trial: N/A

Are Healthy Volunteers Accepted for this Clinical Trial?: No

Lead Sponsor: Accelerated Community Oncology Research Network

Overall Clinical Trial Officials and Contacts

Vasily Assikis, MD Principal Investigator Peachtree Hematology Oncology Consultants  

Information obtained from ClinicalTrials.gov on August 29, 2008

Link to the current ClinicalTrials.gov record. http://clinicaltrials.gov/show/NCT00452387

Study ID Number: ACORN AVAHRPC0607

ClinicalTrials.gov Identifier: NCT00452387

Health Authority: United States: Institutional Review Board