A Phase 2 Study of Pembrolizumab Plus 177Lu-PSMA-617 in Patients With Metastatic Castration Resistant Prostate Cancer
Summary
This is a single-center, open-label, study of Prostate-Specific Membrane Antigen (PSMA)-targeted radionuclide therapy with 177Lu-PSMA-617 in combination with pembrolizumab in participants with metastatic castrate-resistant prostate cancer (mCRPC) who have previously progressed on at least one prior androgen pathway inhibitor (e.g., abiraterone, enzalutamide, apalutamide).
Detailed description
PRIMARY OBJECTIVE: I. To determine the 12-month radiographic progression-free survival rate per Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 and Prostate Cancer Clinical Trials Working Group 3 (PCWG3) criteria in patients with mCRPC treated with pembrolizumab and 177Lu-PSMA-617. SECONDARY OBJECTIVES: I. To determine the median radiographic progression-free survival per RECIST v. 1.1 and PCWG3 criteria in patients with mCRPC treated with pembrolizumab and 177Lu-PSMA-617. II. To determine the objective response rate per RECIST v. 1.1 and PCWG3 criteria in patients with mCRPC treated with pembrolizumab and 177Lu-PSMA-617. III. To determine the median duration of objective response per RECIST v. 1.1 and PCWG3 criteria in patients with mCRPC treated with pembrolizumab and 177Lu-PSMA-617. IV. To determine the greater than 50% decline from baseline PSA (PSA50) and greater than 90% decline from baseline PSA (PSA90) response rate by PCWG3 criteria at any time point on study, as well as individually following each dose of 177Lu-PSMA-617. V. To determine the median time to PSA progression (TTPP) following each dose of 177Lu-PSMA-617 (e.g., TTPP-1, TTPP-2, etc.), as measured by PCWG3 criteria. VI. To determine the median overall survival in patients with mCRPC treated with pembrolizumab and 177Lu-PSMA-617. VII. To characterize the safety profile of the combination of pembrolizumab and 177Lu-PSMA-617 in patients with mCRPC. EXPLORATORY OBJECTIVES: I. To determine the lesion-specific response by baseline uptake on PSMA PET. II. To determine the patterns of PSMA expression at the time of each TTPP event and at radiographic progression. III. To further characterize the tumor microenvironment using Single-cell RNA sequencing (scRNA-seq) of paired metastatic tumor biopsies (a biopsy is required if there is an accessible lesion). IV. To develop a biomarker predictive of durable response based on Cytometry by time of flight (CyTOF) profiling of whole blood samples collected at baseline and early time points on treatment. V. To determine whether successive doses of 177Lu-PSMA-617 leads to ablation of effector T cells and up- regulation of myeloid cell states in the periphery and tumor microenvironment. VI. To characterize participant reported outcomes using the Brief Pain Inventory and The Functional Assessment of Cancer Therapy - Prostate (FACT-P) instruments. VII. To correlate the number of 177Lu-PSMA-617 re-priming doses and PSA progression events with radiographic rPFS. VIII. To evaluate and compare the efficacy of 177Lu-PSMA-617 between the subgroup of participants who received a single dose of 177Lu-PSMA-617 followed by adaptive dosing, and the subgroup of participants who received two doses of 177Lu-PSMA-617 followed by adaptive dosing. IX. To evaluate and compare efficacy between the subgroup of participants who received Schedule 1 versus Schedule 2 dosing. X. To evaluate and compare efficacy between the subgroup of participants who have received prior taxane chemotherapy versus participants who were taxane-naïve at the time of study entry. OUTLINE: Participants will receive two doses of 177Lu-PSMA-617 and may continue treatment for up to a total of six total doses in the absence of unequivocal clinical progression, or unacceptable toxicity, with minimum interval of 6 weeks between doses. Participants will also receive pembrolizumab and may continue study treatment until unequivocal evidence of clinical progression or at physician's discretion based on clinical evaluation. Participants will undergo safety follow-up visits approximately 30 days and 90 days following the end of treatment visit. Participants will then be seen in clinic or contacted by telephone every 3 months to assess survival/disease/anti-cancer therapy status until death, withdrawal of consent, or the end of the study, whichever occurs first until study closure.
Arms & interventions
- DrugPembrolizumab
Given IV
- Drug177Lu-PSMA-617
Given IV
Outcome measures
Primary
Median radiographic progression-free survival (rPFS) at 12 months
rPFS is defined as the amount of time from the initiation of study therapy and the day of first documented radiographic disease progression per RECIST version 1.1 and PCWG3 criteria. The proportion of patients without radiographic progression at 12 months from initiation of trial therapy will be reported along with the 95% confidence interval.
Time frame: 12 months
Secondary
Overall median radiographic rPFS
Time frame: Up to 5 years
Objective response rate (ORR)
Time frame: Up to 10 months
Median duration of objective response (DOR)
Time frame: Up to 10 months
Proportion of participants with 50% decline in PSA (PSA50)
Time frame: Up to 10 months
Proportion of participants with 90% decline in PSA (PSA90)
Time frame: Up to 10 months
Median time to PSA progression (TTPP1) following the first dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the first dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the first dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median time to PSA progression (TTPP2) following the second dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the second dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the second dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median time to PSA progression (TTPP3) following the third dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the third dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the third dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median time to PSA progression (TTPP4) following the fourth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the fourth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the fourth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median time to PSA progression (TTPP5) following the fifth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the fifth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the fifth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median time to PSA progression (TTPP6) following the sixth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA50 following the sixth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Proportion of participants with PSA90 following the sixth dose of 177Lu-PSMA-617
Time frame: Up to 10 months
Median overall survival (OS)
Time frame: Up to 5 years
Percentage of participants with reported treatment-emergent adverse events
Time frame: Up to 10 months
Eligibility criteria
Study locations (1)
University of California, San Francisco
San Francisco, California, 94143